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Individual

MRS. JENNA LYNN DECRAENE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
A.T.C., LAT

Contact information

Practice address
7920 W JEFFERSON BLVD, SUITE 100, FORT WAYNE, IN 46804-4168
(260) 459-0917
Mailing address
952 SKILLET AVE, HUNTERTOWN, IN 46748-0109
(260) 515-0065

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001248A
IN

Other

Enumeration date
04/14/2006
Last updated
08/27/2022
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