Healthcare Provider Details

I. General information

NPI: 1912103359
Provider Name (Legal Business Name): AMY JO FISHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TAYLOR STATION RD SUITE 360
COLUMBUS OH
43213-4440
US

IV. Provider business mailing address

150 TAYLOR STATION RD SUITE 360
COLUMBUS OH
43213-4440
US

V. Phone/Fax

Practice location:
  • Phone: 614-546-3936
  • Fax: 614-546-3918
Mailing address:
  • Phone: 614-546-3936
  • Fax: 614-546-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN0000156343
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number35700
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: