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General NPI Number Information
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NPI Number | 1508297599
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Entity Type | Individual
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Provider Name | CONNIE FISK N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1 COMMONS ST
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City | RUTLAND
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State | VT
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Zip | 05701-4652
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Country | US
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Telephone | 802-747-1857
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Fax | 802-747-1026
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Provider Business Mailing Address
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Address Line | 160 ALLEN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4560
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Country | US
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Telephone | 802-747-1857
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Fax | 802-747-0129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0134648
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F401672
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License Number State | NY
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