Individual
NICOLE A BLACKOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
625 ENTERPRISE DR, OAK BROOK, IL 60523-8813
(715) 558-1268
Mailing address
2300 FIELDCREST DR, MUNDELEIN, IL 60060-5352
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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