Individual
DR. WILLA C FORNETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO, MS
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Mailing address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
49282-021
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
49282-21
WI
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
49282
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43534400
—
WI
Enumeration date
08/24/2006
Last updated
07/21/2022
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