Individual
MRS. MELISSA KRISTINE VANGIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
400 N PLEASANT AVE, CENTRALIA, IL 62801-3056
(618) 436-8641
Mailing address
829 W EDWARDS ST, VANDALIA, IL 62471-2653
(618) 283-2756
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96002127
IL
Other
Enumeration date
02/16/2006
Last updated
07/08/2007
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