MEDICARE: MICHAEL JOSEPH FISHER FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	10041706	OR
2	363LF0000X	Family Nurse Practitioner	AP70007887	WA

General Provider Information

NPI Number	:	1275277527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH FISHER FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 3068
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3068
Country	:	US
Telephone Number	:	503-229-7976
Fax Number	:	503-274-4867

Provider Business Practice Location Address
First Line	:	8050 SW WARM SPRINGS ST STE 150
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7422
Country	:	US
Telephone Number	:	503-692-7971
Fax Number	:	503-691-6837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	09/25/2025

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