Healthcare Provider Details

I. General information

NPI: 1710897368
Provider Name (Legal Business Name): FNU ANUSHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SECOND STREET NEENAH WI 54956
NEENAH WI
54956
US

IV. Provider business mailing address

130 SECOND STREET NEENAH WI 54956
NEENAH WI
54956
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-3100
  • Fax:
Mailing address:
  • Phone: 920-729-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number102487-851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: