Healthcare Provider Details

I. General information

NPI: 1497813323
Provider Name (Legal Business Name): WILLIAM FREDERICK FASCHING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 US HIGHWAY 14
VIROQUA WI
54665-8601
US

IV. Provider business mailing address

1101 US HIGHWAY 14
VIROQUA WI
54665-8601
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-8107
  • Fax: 608-637-7899
Mailing address:
  • Phone: 608-637-8107
  • Fax: 608-637-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number526
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: