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General NPI Number Information
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NPI Number | 1851797674
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Entity Type | Individual
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Provider Name | ANN ELIZABETH WIRINGA MPH, CPH, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 513 S MILTON AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-3750
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Country | US
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Telephone | 718-635-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 513 S MILTON AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-3750
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Country | US
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Telephone | 718-635-3808
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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 | RT004501
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License Number State | PA
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