Individual
ANDREA L DETTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1313 FISH HATCHERY RD, MADISON, WI 53715-1911
(608) 250-8000
(608) 252-8268
Mailing address
1313 FISH HATCHERY RD, MADISON, WI 53715-1911
(608) 250-8000
(608) 252-8268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3587-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770952442
—
WI
01
—
P01726831
RAILROAD MEDICARE
WI
Enumeration date
09/23/2015
Last updated
01/22/2021
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