Individual
JILLIAN FRANCES NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
6119 CTH Y # 13, HAZELHURST, WI 54531-9762
(715) 564-4326
Mailing address
6119 CTH Y # 13, HAZELHURST, WI 54531-9762
(715) 564-4326
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1059-039
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1059-039
WI STATE LICENSURE
WI
01
—
2000000365
BOC CERTIFICATION NUMBER
—
Enumeration date
03/04/2010
Last updated
08/15/2023
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