Healthcare Provider Details

I. General information

NPI: 1568582658
Provider Name (Legal Business Name): ROBIN FISKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLACK COAL DRIVE
FORT WASHAKIE WY
82514
US

IV. Provider business mailing address

312 N 2ND ST
LANDER WY
82520-2807
US

V. Phone/Fax

Practice location:
  • Phone: 307-335-5942
  • Fax: 307-332-3949
Mailing address:
  • Phone: 307-332-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR027698
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: