Individual
ANDREA SHANELL ITTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1912 SW ASPEN ST, BENTONVILLE, AR 72712-7754
(918) 406-8170
Mailing address
1912 SW ASPEN ST, BENTONVILLE, AR 72712-7754
(918) 406-8170
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
539
AR
Other
Enumeration date
06/19/2017
Last updated
07/21/2022
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