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NPI Code Detail

MEDICARE: JENNIFER MARY WOS LAT

MEDICARE: JENNIFER MARY WOS LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer1207-039WI

General Provider Information

NPI Number : 1982974606
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARY WOS LAT
Provider Business Mailing Address
First Line : 405 SOUTHTOWNE DR
Second Line : #K208
City : SOUTH MILWAUKEE
State : WI
Zip : 53172-4280
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1025 N BROADWAY
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-3109
Country : US
Telephone Number : 414-277-2588
Fax Number : 414-277-2495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2012
Last Update Date : 01/11/2012

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