Healthcare Provider Details

I. General information

NPI: 1588928238
Provider Name (Legal Business Name): NICOLLE MARIE FISCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLLE SPARAGON

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST SUITE 113
AMES IA
50010-6083
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-3006
  • Fax: 515-232-3009
Mailing address:
  • Phone: 920-663-7190
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002258
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: