Basic Information
| Provider Information | |||||||||
| NPI: | 1154755908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISCUS ASP | ||||||||
| FirstName: | VANESSA | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT JEWETT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167405128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147782298 | ||||||||
| FaxNumber: | 8147787344 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT JEWETT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167405128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147782298 | ||||||||
| FaxNumber: | 8147787344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP022859 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | RN629502 | PA | N | Nursing Service Providers | Registered Nurse |
No ID Information.