Healthcare Provider Details

I. General information

NPI: 1457167819
Provider Name (Legal Business Name): FIONA MARILYN WYSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9922 LOUETTA RD
HOUSTON TX
77070-1468
US

IV. Provider business mailing address

810 RAYFORD RD APT 2204
SPRING TX
77386-1961
US

V. Phone/Fax

Practice location:
  • Phone: 346-721-9854
  • Fax:
Mailing address:
  • Phone: 832-312-1346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number741020
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number741020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: