Healthcare Provider Details

I. General information

NPI: 1861831679
Provider Name (Legal Business Name): CONSTANCE FAZIO DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 LINDEN DR UW VETERINARY CARE
MADISON WI
53706-1100
US

IV. Provider business mailing address

2015 LINDEN DR UW VETERINARY CARE
MADISON WI
53706-1100
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-7600
  • Fax:
Mailing address:
  • Phone: 608-263-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6451-50
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: