Jenna Lynn Decraene, A.T.C., LAT
Specialist/Technologist, Athletic Trainer in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1902860141
StatusActive
Last updated in NPPESAug 27, 2022
Details
- NPI
- 1902860141
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Jenna Lynn Decraene
- Credential
- A.T.C., LAT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 14, 2006
- Certification date
- Aug 27, 2022
- Last updated
- Aug 27, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 36001248A | IN | Yes |
Practice location
7920 W Jefferson BlvdSuite 100
Fort Wayne, IN 46804-4168
Phone 260-459-0917
Mailing address
952 Skillet AveHuntertown, IN 46748-0109
Phone 260-515-0065
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