Provider Demographics
NPI:1265758445
Name:FISKE, HAYDEE (FNP)
Entity type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
Last Name:FISKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 GATEWAY BLVD W
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4225
Mailing Address - Country:US
Mailing Address - Phone:915-598-7246
Mailing Address - Fax:915-633-6598
Practice Address - Street 1:3215 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4225
Practice Address - Country:US
Practice Address - Phone:915-598-7246
Practice Address - Fax:915-633-6598
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX648534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214469303Medicaid