Healthcare Provider Details

I. General information

NPI: 1265701155
Provider Name (Legal Business Name): LORAINE A FISHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORAINE A RABB RN

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 03/07/2023
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 EDISON LAKES PKWY
MISHAWAKA IN
46545-3448
US

IV. Provider business mailing address

3740 EDISON LAKES PKWY
MISHAWAKA IN
46545-3448
US

V. Phone/Fax

Practice location:
  • Phone: 574-252-4150
  • Fax:
Mailing address:
  • Phone: 574-252-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003921A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: