Individual
SAMUEL DAVID GJERSET VANDEHAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(715) 944-9037
Mailing address
1737 BRICKYARD LN, CHIPPEWA FALLS, WI 54729-2294
(715) 944-9037
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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