Individual
MARIAH GIESSEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-2681
Mailing address
4910 FOREST RD, STURGEON BAY, WI 54235-8896
(920) 743-5464
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1624-39
WI
Other
Enumeration date
04/21/2015
Last updated
04/21/2015
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