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General NPI Number Information
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NPI Number | 1376093492
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Entity Type | Individual
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Provider Name | NICHOLAS HARTWIGSEN MS, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 1903 W MICHIGAN AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-5200
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Country | US
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Telephone | 952-221-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 765 ALFA CT APT 2B
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City | PORTAGE
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State | MI
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Zip | 49002-2981
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Country | US
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Telephone | 952-221-4744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001570
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License Number State | MI
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