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NPI Code Detail

MEDICARE: MR. ANTHONY YAROSLAV FISUN CRNP

MEDICARE: MR. ANTHONY YAROSLAV FISUN CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerSP014633PA
2363LG0600XGerontology Nurse PractitionerSP014633PA

General Provider Information

NPI Number : 1306223813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY YAROSLAV FISUN CRNP
Provider Business Mailing Address
First Line : 2008 PRESIDENT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-2607
Country : US
Telephone Number : 215-200-0420
Fax Number :
Provider Business Practice Location Address
First Line : 2008 PRESIDENT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-2607
Country : US
Telephone Number : 215-200-0420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2015
Last Update Date : 12/09/2015

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