Individual
KAYLA MARIE HENNUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 2ND ST N, FARGO, ND 58102-2722
(218) 766-8475
Mailing address
1225 2ND ST N, FARGO, ND 58102-2722
(218) 766-8475
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456
ATHLETIC TRAINING
ND
Enumeration date
02/13/2019
Last updated
02/13/2019
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