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General NPI Number Information
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NPI Number | 1669499133
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Entity Type | Individual
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Provider Name | DWIGHT FISKE PA-C, RN, AEMT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 HEMLOCK ST
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City | TAWAS CITY
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State | MI
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Zip | 48763-9237
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Country | US
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Telephone | 989-362-3411
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Fax | 989-362-9925
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Provider Business Mailing Address
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Address Line | 902 W 1ST ST
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City | TAWAS CITY
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State | MI
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Zip | 48763-9688
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Country | US
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Telephone | 989-820-8127
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601003088
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License Number State | MI
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