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1043905185
AVERY FOSSUM
MADISON, WI
NPI
1043905185
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2023-04-05
Last Update Date
2023-04-05
Business Address
AVERY FOSSUM
858 JUPITER DR
MADISON, WI 53718-2946
Phone number: 608-222-7511
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Mailing Address
AVERY FOSSUM
3053 OAK LEAF CIR
FITCHBURG, WI 53711-5846
Phone number: 608-514-3808
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