MEDICARE: JILLIAN RENEE FISHER FNP-C

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	024343	OH

General Provider Information

NPI Number	:	1972060507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN RENEE FISHER FNP-C

Provider Business Mailing Address
First Line	:	2481 MONTCLAIR AVE
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-1319
Country	:	US
Telephone Number	:	843-504-4880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1874 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2263
Country	:	US
Telephone Number	:	330-262-2500
Fax Number	:

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

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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