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Individual

KENNEDY MARIAH HOLWERDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
400 OLENA AVE, WILLMAR, MN 56201-4538
(320) 444-8903
Mailing address
400 OLENA AVE, WILLMAR, MN 56201-4538

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
MN

Other

Enumeration date
10/01/2017
Last updated
10/01/2017
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