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General NPI Number Information
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NPI Number | 1326679663
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Entity Type | Individual
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Provider Name | ANDREA MARIA DOSEDLA
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Gender | Female
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | N61W23044 HARRYS WAY
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City | SUSSEX
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State | WI
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Zip | 53089-3995
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Country | US
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Telephone | 414-566-7627
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 S 75TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-3020
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Country | US
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Telephone | 262-210-7127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 1682-39
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License Number State | WI
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