Provider Demographics
NPI:1013525534
Name:FISKE, JAMES TUTU I (DNP/PMHNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TUTU
Last Name:FISKE
Suffix:I
Gender:M
Credentials:DNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 MINNESOTA DR STE 170
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5202
Mailing Address - Country:US
Mailing Address - Phone:612-927-2040
Mailing Address - Fax:952-400-5602
Practice Address - Street 1:3601 MINNESOTA DR STE 170
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5202
Practice Address - Country:US
Practice Address - Phone:844-994-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11098363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health