Active NPI
Dawn B Fishback, R.N.
- Registered Nurse
- Victor, NY
National Provider Identifier
1790987600
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Jul 20, 2016.
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 502649-1
- Practice address
- 1605 Strong Rd
Victor, NY 14564-9352 - Phone
- (585) 924-0459
- NPI assigned
- Jun 3, 2007
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 502649-1 | NY | Primary |
Addresses
Primary practice location
1605 Strong Rd
Victor, NY 14564-9352
Mailing address
25 Hillside Dr
Geneva, NY 14456-1522
Phone (315) 789-9764
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02691578 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 502649-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1790987600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 HILLSIDE DR",
"city": "GENEVA",
"state": "NY",
"postal_code": "144561522",
"telephone_number": "315-789-9764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 STRONG RD",
"city": "VICTOR",
"state": "NY",
"postal_code": "145649352",
"telephone_number": "585-924-0459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHBACK",
"first_name": "DAWN",
"middle_name": "B",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "502649-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02691578",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Victor, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.