Individual
LORRIE ANN FORMELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
604 N RICHMOND ST, APPLETON, WI 54911-4659
(920) 750-1845
Mailing address
N7590 LOWER CLIFF RD, SHERWOOD, WI 54169-9704
(920) 750-1845
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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