Healthcare Provider Details

I. General information

NPI: 1215414099
Provider Name (Legal Business Name): RACHELLE LONG FISCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 2ND AVE NE
ROLLA ND
58367-7153
US

IV. Provider business mailing address

602 5TH ST NE
ROLLA ND
58367-7320
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-3161
  • Fax:
Mailing address:
  • Phone: 703-477-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR46513
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: