Healthcare Provider Details

I. General information

NPI: 1063534550
Provider Name (Legal Business Name): RODNEY L FISHER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19555 N 59TH AVE # 623
GLENDALE AZ
85308-6813
US

IV. Provider business mailing address

19555 N 59TH AVE
GLENDALE AZ
85308-6813
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-3762
  • Fax:
Mailing address:
  • Phone: 801-375-8049
  • Fax: 623-572-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number211945-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number211945-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: