Healthcare Provider Details

I. General information

NPI: 1093154015
Provider Name (Legal Business Name): BRYAN FISHER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRONT ST STE 100
EXETER NH
03833-2727
US

IV. Provider business mailing address

PO BOX 3300
MANCHESTER NH
03105-3300
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number054113-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: