Individual
MR. EVAN RICHARD MULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DAT, LAT, OTC
Contact information
Practice address
501 N 10TH ST, MANITOWOC, WI 54220
(920) 682-6376
(920) 652-0115
Mailing address
164 N BROADWAY, GREEN BAY, WI 54303-2728
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1554-39
MN
2255A2300X
Athletic Trainer
Primary
1554-39
WI
Other
Enumeration date
10/15/2014
Last updated
02/11/2019
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