Individual
NICHOLAS ANTONELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2817 REILLY RD, WAMC CREDENTIALING, FORT BRAGG, NC 28310
(517) 896-0261
Mailing address
2817 REILLY ST, FORT BRAGG, NC 28310-7324
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002358A
IN
Other
Enumeration date
03/03/2016
Last updated
07/29/2022
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