Provider Demographics
NPI:1467960955
Name:TOWNSEND, FAWN (FNP)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:LILLIAN
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1233
Mailing Address - Country:US
Mailing Address - Phone:920-563-5571
Mailing Address - Fax:
Practice Address - Street 1:530 LYTTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1541
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:844-640-3975
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017027605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily