Provider Demographics
NPI:1265897821
Name:EDWARDS, NICOLE M (ATC, LAT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:BUEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2700 W 9TH AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-223-0636
Practice Address - Fax:920-223-0370
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1074-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer