Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 123157 | AR |
NPI | 1003455833 |
---|---|
Provider Name | Elizabeth Fiser |
First Address | Little Rock, AR 72205-2178 |
Second Address | Little Rock, AR 72205-2178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2019 |
Last Update Date | 26/12/2019 |