Individual
MRS. LYDIA G TANNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
3046 CONESTA DR APT 1, GREEN BAY, WI 54311-4986
(920) 323-0880
Mailing address
3046 CONESTA DR APT 1, GREEN BAY, WI 54311-4986
(920) 323-0880
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/14/2014
Last updated
04/14/2014
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