Provider Demographics
NPI:1447745021
Name:FAGA, CHLOE BEA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CHLOE
Middle Name:BEA
Last Name:FAGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:BEA
Other - Last Name:VANDERWEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2108 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9621
Mailing Address - Country:US
Mailing Address - Phone:920-946-7547
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-251-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant