Individual
STACI MARIE GRUENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, CSCS
Contact information
Practice address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-5482
Mailing address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
670-039
WI
Other
Enumeration date
02/13/2007
Last updated
09/01/2016
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