Healthcare Provider Details

I. General information

NPI: 1699791210
Provider Name (Legal Business Name): DONALD E. FONCREE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WEST AVENUE S. DDHS
LA CROSSE WI
54601-4783
US

IV. Provider business mailing address

700 WEST AVENUE S.
LA CROSSE WI
54601-4783
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-7000
  • Fax: 608-392-7808
Mailing address:
  • Phone: 608-392-7000
  • Fax: 608-392-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2480-033
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2480
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2480-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: