Individual
JANA RAVEN PONDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
420 OAKWOOD ST SE, WASHINGTON, DC 20032-1619
(202) 549-4263
Mailing address
420 OAKWOOD ST SE, WASHINGTON, DC 20032-1619
(202) 549-4263
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000038384
—
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/25/2019
Last updated
06/10/2020
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