Healthcare Provider Details

I. General information

NPI: 1811971021
Provider Name (Legal Business Name): FANNY T NISBET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W PRINCE RD
TUCSON AZ
85705-3526
US

IV. Provider business mailing address

320 W PRINCE RD
TUCSON AZ
85705-3526
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-3909
  • Fax: 520-388-7170
Mailing address:
  • Phone: 520-792-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20324
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: