Healthcare Provider Details

I. General information

NPI: 1790963940
Provider Name (Legal Business Name): DANIEL SCOTT FISKE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 I ST
SACRAMENTO CA
95814-2400
US

IV. Provider business mailing address

651 I ST
SACRAMENTO CA
95814-2400
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-5222
  • Fax:
Mailing address:
  • Phone: 916-874-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number349580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: