Healthcare Provider Details

I. General information

NPI: 1336994367
Provider Name (Legal Business Name): JONATHAN DREWSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FORDEM AVE
MADISON WI
53704-4600
US

IV. Provider business mailing address

PO BOX 930093
VERONA WI
53593-0093
US

V. Phone/Fax

Practice location:
  • Phone: 608-455-6070
  • Fax:
Mailing address:
  • Phone: 920-539-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7939-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: