Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 243272 | AZ |
NPI | 1013525534 |
---|---|
Provider Name | James Tutu Fiske I |
First Address | Tucson, AZ 85712 |
Second Address | Tucson, AZ 85712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 21/07/2020 |