Individual
JADE NYCOLE AGUILAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5945 WATERSIDE DR APT 2, PORTAGE, IN 46368-4933
(219) 617-7855
Mailing address
5945 WATERSIDE DR APT 2, PORTAGE, IN 46368-4933
(219) 617-7855
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
10/16/2018
Last updated
10/16/2018
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