Healthcare Provider Details

I. General information

NPI: 1083185235
Provider Name (Legal Business Name): CHERYL FISH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 E GALA CT STE 110
MERIDIAN ID
83642-2791
US

IV. Provider business mailing address

2667 E GALA CT STE 110
MERIDIAN ID
83642-2791
US

V. Phone/Fax

Practice location:
  • Phone: 208-944-2354
  • Fax:
Mailing address:
  • Phone: 208-944-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95010116
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60167
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number807738
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: