Individual
SAMANTHA FEDOROWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1211 FISH HATCHERY RD, MADISON, WI 53715-1909
(608) 252-8000
(608) 288-6490
Mailing address
1805 BELD ST, MADISON, WI 53713-1309
(608) 807-9754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8010-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851024145
—
WI
Enumeration date
07/05/2022
Last updated
12/04/2024
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