ANDREA L DETTMAN


Address: 1313 Fish Hatchery Rd, Madison, WI 53715-1911
Phone: 6082508000

ANDREA L DETTMAN (NPI# 1770952442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1770952442
Entity Type Individual
Full Name ANDREA L DETTMAN
Credential PA-C
Practice Address 1313 Fish Hatchery Rd
Madison
WI 53715-1911
Practice Telephone 6082508000
Practice Fax Number 6082528268
Mailing Telephone 6082508000
Mailing Fax Number 6082528268
Enumeration Date 2015-09-23
Last Update Date 2018-04-19
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 3587-23 WI Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WI 1770952442 05
WI RAILROAD MEDICARE P01726831 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
1313 Fish Hatchery Rd, Madison, WI 537151911 6082528000 6082528268

Office Location

Street Address 1313 FISH HATCHERY RD
City MADISON
State WI
Zip Code 53715-1911

Providers in the same location

NPI Name Taxonomy Address Enumeration
1356335269 Paul A Boeder Obstetrics & Gynecology 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2005-09-07
1780202663 Julie Armstrong Nurse Practitioner 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2020-07-08
1316580517 Kelly Nicole Morgan Clinical Neuropsychologist 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2019-10-21
1952952921 Drew A Roenneburg Physician Assistant 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2019-09-21
1386299154 Antonia Efua Bertram Nurse Practitioner 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2019-08-07
1407314081 Tempesst L Merricks Nurse Practitioner 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2019-03-04
1588133219 Jorja Gander Pharmacist 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2018-11-26
1841772381 Jessica M Vaughan Advanced Practice Midwife 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2018-08-31
1295216430 Sarah A Vadnais Clinical Neuropsychologist 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2018-08-26
1063906451 Anthony P Rinaldi Psychologist 1313 Fish Hatchery Rd, Madison, WI 53715-1911 2018-06-19
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1851807697 Kristi M Batchelor Nurse Practitioner 20 S Park St Fl 4, Madison, WI 53715 2017-12-15
1578927026 Petra A Kelsey Family Medicine 1107 Emerald St, Madison, WI 53715 2016-04-11
1467889238 Group Health Cooperative of South Central Wi Durable Medical Equipment & Medical Supplies 740 Regent Street, Suite 106, Madison, WI 53715 2013-10-10
1275888760 Sandra Beth Miller Physician Assistant 700 S. Park, Suite A 404, Madison, WI 53715 2012-07-20
1134418486 Matthew Lochen Emergency Medicine 700 S. Park Street, Department of Emergency Medicine, Madison, WI 53715 2011-04-06
1225275720 Eileen J Breitweiser Social Worker 202 South Parkt Street, Madison, WI 53715 2009-01-21
1225293137 Kenneth H. Yuska, Md, Sc Orthopaedic Surgery 4726 East Towne Blvd., 110, Madison, WI 53715 2008-07-21
1063689727 Rachel I Kornik Dermatology Uw Health Dept of Dermatology 1 S. Park St, Administrative Office 7th Floor, Madison, WI 53715 2008-05-13
1144434911 Rebecca Sue Frye Pharmacist 1 South Park Street, Suite 101 Pharmacy, Madison, WI 53715 2007-05-10
1376755496 Eileen C. Scrivner Social Worker 1008 Fish Hatchery Road, Madison, WI 53715 2007-05-03
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1710594403 Mary Josephine Elliott Physician Assistant 50 Beechwood Dr, Madison, CT 06443-1847 2020-09-26
1194354928 Shqipe Ademi Physician Assistant 5417 Hazelcrest Dr, Madison, WI 53704-8910 2020-04-03
1902432685 Therese Rowe Physician Assistant 1 Point Pl Ste 200, Madison, WI 53719-2836 2020-03-13
1437784139 Mark Mckinney Physician Assistant 750 Highland Ave # Hslc1270, Madison, WI 53705-2221 2020-03-03
1619511706 Nicole Frakes Physician Assistant 750 Highland Ave, Madison, WI 53705-2221 2019-10-31
1508428558 Martha Busse Physician Assistant 1650 Monroe St Apt D, Madison, WI 53711-2045 2019-06-30
1669942249 Patrick Soltvedt Bohn Physician Assistant 1034 Waban Hill, Madison, WI 53711 2018-11-27
1487124020 Kaitlyn Jolena Mcmackin Physician Assistant 120 Fountains Blvd Ste 1000, Madison, MS 39110-6343 2018-11-27
1013493907 Paulina A Hall Physician Assistant 700 S Park St Suite A, Madison, WI 53715-5228 2018-07-13
1700370020 Mark Diaz IIi Physician Assistant 77 S Oakbridge Ct Apt 105, Madison, WI 53717-2030 2018-06-20
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Competitor

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City MADISON
Zip Code 53715

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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