Healthcare Provider Details

I. General information

NPI: 1003515792
Provider Name (Legal Business Name): KRISTINE LYNN FISHER MSN, BSN, RN, AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SAINT PAUL ST
BALTIMORE MD
21202-2123
US

IV. Provider business mailing address

3700 TOONE ST APT 2422
BALTIMORE MD
21224-5161
US

V. Phone/Fax

Practice location:
  • Phone: 717-504-9365
  • Fax:
Mailing address:
  • Phone: 717-504-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR225786
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR225786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: