Individual
AUDREY BROOKE FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4805 S MOORLAND RD, NEW BERLIN, WI 53151-7401
(262) 798-7200
Mailing address
520 PARK RIDGE CT APT H, WINSTON SALEM, NC 27104-5608
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10003168A
IN
363A00000X
Physician Assistant
Primary
7469-23
WI
Other
Enumeration date
01/17/2021
Last updated
08/30/2023
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