Individual
LAURA NICKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2966 ROUTE 34, OSWEGO, IL 60543-8362
(630) 254-1214
Mailing address
2966 ROUTE 34, OSWEGO, IL 60543-8362
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003473
IL
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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