Individual
ANGELA YVONNE PUCHALLA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 655-3005
Mailing address
1445 CARROLL AVE, GREEN BAY, WI 54304-3412
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
549-039
WI
Other
Enumeration date
10/26/2005
Last updated
07/08/2007
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