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Individual

RYAN CHRISTOPHER JOLLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC, EMT-B

Contact information

Practice address
N1457 HILLSIDE RD, LAKE GENEVA, WI 53147-4235
(262) 248-4103
Mailing address
1028 S LAKE SHORE DR, LAKE GENEVA, WI 53147-2235

Taxonomy

Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
70108769
WI
2255A2300X
Athletic Trainer

Other

Enumeration date
11/21/2017
Last updated
11/21/2017
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