Individual
MARION SIDES VRUGGINK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
1105 N GRANT STREET, WEST LAFAYETTE JR SR HIGH SCHOOL, WEST LAFAYETTE, IN 47906
(765) 746-0424
(765) 746-0426
Mailing address
320 DEHART STREET, WEST LAFAYETTE, IN 47906
(765) 746-5706
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000026A
IN
Other
Enumeration date
04/21/2006
Last updated
07/08/2007
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