Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 10633-33 | WI |
NPI | 1013245208 |
---|---|
Provider Name | Mrs. Andrea Fox |
First Address | Mukwonago, WI 53149-9726 |
Second Address | Mukwonago, WI 53149-9726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2009 |
Last Update Date | 12/02/2021 |