Avery Fossum - Madison, WI

Avery Fossum

Student in an Organized Health Care Education/Training Program in Madison, Wisconsin

NPI 1043905185

Avery Fossum is a Student in an Organized Health Care Education/Training Program based in Fitchburg, WI. Avery Fossum practices in Madison, WI. The NPI Number for Avery Fossum is 1043905185 and holds a License No. (Wisconsin).

The current practice location address for Avery Fossum is 858 Jupiter Dr, Madison, WI and can be reached out via phone at 608-222-7511.

Location: 858 Jupiter Dr, Madison, WI, 53711-5846

NPI Number

1043905185

Provider Name

Avery Fossum

Credential

Provider Entity Type

Individual

Gender

Male

Address

858 Jupiter Dr, Madison, WI, 53711-5846

Phone Number

608-222-7511

Fax Number

Provider Enumeration Date

04/05/2023

Last Update Date

03/10/2024

Address

858 Jupiter Dr

City

Madison

State

Wisconsin

Zip

53718-2946

Phone Number

608-222-7511

Fax Number

Address

858 Jupiter Dr

City

Madison

State

Wisconsin

Zip

53718-2946

Phone Number

608-222-7511

Fax Number

Type

Student, Health Care

Classification

Student in an Organized Health Care Education/Training Program

Speciality

Taxonomy

390200000X

License No.

()

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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