Individual
ANNE B. FENWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
901 W BRIDGE ST, NEW LISBON, WI 53950-1083
(608) 562-3111
Mailing address
1040 DIVISION ST, MAUSTON, WI 53948-1931
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
667
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42927600
—
WI
Enumeration date
11/14/2005
Last updated
06/28/2010
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