Healthcare Provider Details

I. General information

NPI: 1841078326
Provider Name (Legal Business Name): CASSEOPIA FISHER AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S WAHANNA RD
SEASIDE OR
97138-7735
US

IV. Provider business mailing address

725 S WAHANNA RD
SEASIDE OR
97138-7735
US

V. Phone/Fax

Practice location:
  • Phone: 503-515-1738
  • Fax:
Mailing address:
  • Phone: 503-515-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number200242230RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10016096
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10016096
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: