Van Fossen, Brenda R

Van Fossen, Brenda R is an individual health care provider with primary practice located at 7375 Oswego Rd , Liverpool NY 13090-3717. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Van Fossen, Brenda R can be contacted via phone (315) 291-0064.

Contact Information

Primary practice address
7375 Oswego Rd Liverpool NY 13090-3717
Phone: (315) 291-0064
Fax: (315) 291-0065
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD00043720 Washington
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 291334 New York

Profile Details

NPI number 1073522587
LBN Legal business name Van Fossen, Brenda R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 5th, 2006
Last updated Mar 22nd, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1073522587 NPPES
Washington Other 0191866 STATE L&I
Washington MEDICAID 8409245 STATE L&I
Washington Other 8939525 STATE L&I

Popular Providers