Individual
MR. DOMINICK MICHAEL HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13188 LAKEVIEW CT, POUND, WI 54161-8818
(920) 373-2836
Mailing address
13188 LAKEVIEW CT, POUND, WI 54161-8818
(920) 373-2836
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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