Individual
AVERY FOSSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
858 JUPITER DR, MADISON, WI 53718-2946
(608) 222-7511
Mailing address
3053 OAK LEAF CIR, FITCHBURG, WI 53711-5846
(608) 514-3808
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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