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General NPI Number Information
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NPI Number | 1467722363
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Entity Type | Individual
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Provider Name | JESSICA ERIN HULDERMAN A.T.C.
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Gender | Female
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 1000 E UNIVERSITY AVE
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City | LARAMIE
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State | WY
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Zip | 82071-2000
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Country | US
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Telephone | 419-205-4612
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Fax | 307-766-2112
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Provider Business Mailing Address
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Address Line | 1000 E UNIVERSITY AVE
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City | LARAMIE
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State | WY
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Zip | 82071-2000
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Country | US
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Telephone | 419-205-4612
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Fax | 307-766-2112
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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 | 45
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License Number State | WY
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