Individual
TARESA B FASSBENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3263 EATON RD STE 1, GREEN BAY, WI 54311-6830
(920) 433-6000
(920) 433-6009
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2429-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11987405
CAQH
—
Enumeration date
06/17/2009
Last updated
10/20/2020
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