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General NPI Number Information
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NPI Number | 1770440133
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Entity Type | Individual
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Provider Name | CAROLINE JEAN KANDRAVI
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Gender | Female
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1970 S RIDGE RD
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City | GREEN BAY
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State | WI
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Zip | 54304-4125
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Country | US
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Telephone | 920-430-4888
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Fax | 920-430-4889
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Provider Business Mailing Address
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Address Line | 1570 QUARRY PARK DR APT 10
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City | DE PERE
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State | WI
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Zip | 54115-7526
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Country | US
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Telephone | 920-471-7299
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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 | 331239
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License Number State | WI
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