Healthcare Provider Details

I. General information

NPI: 1376018630
Provider Name (Legal Business Name): MITCHELL DAVID FISHER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7496 ROCKFISH RD
FAYETTEVILLE NC
28306-8076
US

IV. Provider business mailing address

7496 ROCKFISH RD
FAYETTEVILLE NC
28306-8076
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-216-4213
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-216-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: