Individual
CORNELL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2103 SUMMIT AVE, WAUKESHA, WI 53188-3106
(414) 828-0470
Mailing address
2103 SUMMIT AVE, WAUKESHA, WI 53188-3106
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
567-39
WI
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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