Healthcare Provider Details

I. General information

NPI: 1316869845
Provider Name (Legal Business Name): MANDY FISHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S WAVERLY RD
HOLLAND MI
49423-9121
US

IV. Provider business mailing address

6410 SAND CASTLE DR
HOLLAND MI
49423-8539
US

V. Phone/Fax

Practice location:
  • Phone: 616-312-2859
  • Fax: 616-616-9931
Mailing address:
  • Phone: 317-517-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704284073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: