Individual
BRENDA R VAN FOSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7375 OSWEGO RD, LIVERPOOL, NY 13090-3717
(315) 291-0064
(315) 291-0065
Mailing address
PO BOX 500, ELLICOTTVILLE, NY 14731-0500
(716) 699-9032
(716) 699-9035
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
291334
NY
208000000X
Pediatrics Physician
MD00043720
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0191866
STATE L&I
WA
05
—
8409245
—
WA
01
—
8939525
STATE CRIME VICTIMS
WA
Enumeration date
08/05/2006
Last updated
03/22/2018
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