Individual
MILDRED VANNICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-2111
Mailing address
1806 GREEN ST APT 110, PHILADELPHIA, PA 19130-3971
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT004865
PA
Other
Enumeration date
04/03/2018
Last updated
04/03/2018
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