Healthcare Provider Details

I. General information

NPI: 1467810424
Provider Name (Legal Business Name): LAURA FISCHER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 07/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 301
BEVERLY HILLS CA
90212
US

IV. Provider business mailing address

2725 4TH ST APT 7
SANTA MONICA CA
90405-4231
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2467
  • Fax:
Mailing address:
  • Phone: 317-270-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95077800
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28209089A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: