Provider Demographics
NPI:1528247871
Name:FIESINGER, ELLEN SHEILA (FNP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:SHEILA
Last Name:FIESINGER
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 1:704 OLD MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2740
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:936-521-3964
Practice Address - Street 1:704 OLD MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2740
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-521-3964
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMF1612553OtherDEA