RYAN C JOLLY, ATC, EMT-B LAKE GENEVA, WI

Contact Information

RYAN C JOLLY, ATC, EMT-B

N1457 HILLSIDE RD
LAKE GENEVA, WI 53147-4235

Phone: 262-248-4103
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Emergency Medical Technician, Basic	146N00000X
Athletic Trainer	2255A2300X

Indicates primary specialty

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NPI Profile & details for RYAN C JOLLY · (Male)

NPI Number	`1962916395`
Status	Active
Credentials	ATC, EMT-B
Entity	Individual
Enumeration date	11/21/2017
Last updated	11/21/2017 - About 9 years ago
Sole proprietor ¹	Yes
Identifiers	WI License # 70108769
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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