Healthcare Provider Details

I. General information

NPI: 1215075619
Provider Name (Legal Business Name): DEBORAH A FISCUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11695 NE 4TH ST
BELLEVUE WA
98004-5268
US

IV. Provider business mailing address

1100 9TH AVE MS:M4-PFS
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 425-637-1855
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30001622
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: