Individual
MISS MADELINE DALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 993-1669
Mailing address
N7529 PAWLING PL, HARTLAND, WI 53029
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2095-39
WI
Other
Enumeration date
09/18/2015
Last updated
05/08/2019
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