Healthcare Provider Details

I. General information

NPI: 1710610589
Provider Name (Legal Business Name): FATOU CISSET NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 WINDSOR DR
FRAMINGHAM MA
01701-5007
US

IV. Provider business mailing address

806 WINDSOR DR
FRAMINGHAM MA
01701-5007
US

V. Phone/Fax

Practice location:
  • Phone: 508-308-3801
  • Fax:
Mailing address:
  • Phone: 508-308-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2278071
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2278071
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: