MEDICARE: LISA AMY FASCENDA RNFA

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
1	163WR0006X	Registered Nurse First Assistant	RN9195984	FL

General Provider Information

NPI Number	:	1558532457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA AMY FASCENDA RNFA

Provider Business Mailing Address
First Line	:	5112 VICTORIA CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7846
Country	:	US
Telephone Number	:	561-471-1635
Fax Number	:

Provider Business Practice Location Address
First Line	:	5112 VICTORIA CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7846
Country	:	US
Telephone Number	:	561-471-1635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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