Basic Information
| Provider Information | |||||||||
| NPI: | 1013245208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | W305S5021 STATE ROAD 83 | ||||||||
| Address2: | |||||||||
| City: | MUKWONAGO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531499726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624088172 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8375 S HOWELL AVE | ||||||||
| Address2: | |||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531548344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147645726 | ||||||||
| FaxNumber: | 4147646954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2009 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 169727-030 | WI | N | Nursing Service Providers | Registered Nurse | 363LP0200X | 10633-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1013245208 | 05 | WI | MEDICAID |