Healthcare Provider Details

I. General information

NPI: 1093792384
Provider Name (Legal Business Name): HOPE E REDDINGTON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOPE E WEGERT P.A.

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-4904
  • Fax: 608-262-0674
Mailing address:
  • Phone: 608-265-4904
  • Fax: 608-262-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number934-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: