Provider Demographics
NPI:1790963940
Name:FISKE, DANIEL SCOTT (RN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SCOTT
Last Name:FISKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 I ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2400
Mailing Address - Country:US
Mailing Address - Phone:916-874-5222
Mailing Address - Fax:
Practice Address - Street 1:651 I ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2400
Practice Address - Country:US
Practice Address - Phone:916-874-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349580163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator