Individual
MRS. MARTHA SUE VANEENENAAM-IWANICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
FRASER HIGH SCHOOL, 34270 GARFIELD, FRASER, MI 48026
(586) 879-2398
(586) 415-1079
Mailing address
32347 OXFORD CT, FRASER, MI 48026-2346
(586) 415-0561
(586) 415-1079
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MI
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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