Individual
MS. MANDY R FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
6030 W OKLAHOMA AVE, MILWAUKEE, WI 53219-4133
(414) 546-2992
(414) 546-2996
Mailing address
6030 W OKLAHOMA AVE, MILWAUKEE, WI 53219-4133
(414) 546-2992
(414) 546-2996
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209022884
IL
363L00000X
Nurse Practitioner
Primary
2743-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36003900
—
WI
Enumeration date
07/25/2006
Last updated
12/01/2021
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