Individual
MARK ALLEN KWIKKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
310 N 10TH, BLAIR, NE 68008
(402) 427-2777
Mailing address
3000 HUTTON DR, DECATUR, NE 68020-2205
(402) 349-5357
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
11
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4023495357
OFFICE
—
Enumeration date
07/17/2020
Last updated
07/17/2020
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