Provider Demographics
NPI:1043823511
Name:FENDER, ELYSE LOUISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:LOUISE
Last Name:FENDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30164 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4539
Mailing Address - Country:US
Mailing Address - Phone:661-305-8092
Mailing Address - Fax:
Practice Address - Street 1:23823 VALENCIA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-9516
Practice Address - Country:US
Practice Address - Phone:661-243-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner