Individual
AMANDA SHOBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
W260N5417 GLEN RIDGE RD, SUSSEX, WI 53089-4266
(262) 719-0396
Mailing address
W260N5417 GLEN RIDGE RD, SUSSEX, WI 53089-4266
(262) 719-0396
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Enumeration date
09/10/2015
Last updated
06/14/2016
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