Provider Demographics
NPI:1225172539
Name:FISET, ELIZABETH MCLAREN (DOM)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MCLAREN
Last Name:FISET
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2319 CALLE LUMINOSO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5609
Mailing Address - Country:US
Mailing Address - Phone:505-438-4308
Mailing Address - Fax:505-474-4761
Practice Address - Street 1:2319 CALLE LUMINOSO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5609
Practice Address - Country:US
Practice Address - Phone:505-438-4308
Practice Address - Fax:505-474-4761
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM454171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist