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Contact Information

EVAN R MULDER, DAT, LAT, OTC
501 N 10TH ST
MANITOWOC, WI54220
 Phone: 920-682-6376
 Fax: 920-652-0115
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for EVAN R MULDER · (Male)

NPI Number 1356745640
Status Active
Credentials DAT, LAT, OTC
Entity Individual
Enumeration date 10/15/2014
Last updated 02/11/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • MN License # 1554-39
  • WI License # 1554-39
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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