Individual
ALICIA-MARIA FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
402 W LAKE ST, FRIENDSHIP, WI 53934-9699
(608) 339-3331
Mailing address
402 W LAKE ST, FRIENDSHIP, WI 53934-9699
(608) 339-3331
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
50947
WI
208000000X
Pediatrics Physician
50947
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43545200
—
WI
01
—
K400386662
MEDICARE PIN
WI
Enumeration date
10/03/2007
Last updated
07/21/2022
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