Individual
DALTON VENDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
448 W MADISON ST, WATERLOO, WI 53594-1325
(920) 988-8312
Mailing address
448 W MADISON ST, WATERLOO, WI 53594-1325
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001252
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000013236
BOARD OF CERTIFICATION-ATHLETIC TRAINER CERTIFICATION NUMBER
—
Enumeration date
04/04/2015
Last updated
04/04/2015
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