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Individual
DEBRA IWANOW
Active
Individual
DEBRA IWANOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, CSCS
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001234
NY
2255A2300X
Athletic Trainer
AL3019
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001234
NEW YORK STATE LICENSE
NY
01
—
AL3019
FLORIDA STATE LICENSE
FL
Enumeration date
06/18/2020
Last updated
06/18/2020
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