Provider Demographics
NPI:1750686309
Name:FISK, PAMELA SUSAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUSAN
Last Name:FISK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53932-9570
Mailing Address - Country:US
Mailing Address - Phone:608-921-1976
Mailing Address - Fax:
Practice Address - Street 1:652 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:WI
Practice Address - Zip Code:53932-9570
Practice Address - Country:US
Practice Address - Phone:608-921-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154734-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse