Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | NP95005350 | CA |
NPI | 1306205109 |
---|---|
Provider Name | Dr. Kisha A. Fausett |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2016 |
Last Update Date | 10/11/2021 |