Individual
NICHOLAS SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
367H00000X
Anesthesiologist Assistant
Primary
195-17
WI
Other
Enumeration date
08/29/2014
Last updated
10/29/2021
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