Healthcare Provider Details

I. General information

NPI: 1043436645
Provider Name (Legal Business Name): JANE ROSE FISCHER BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MAIN ST
WHITEWATER WI
53190-1705
US

IV. Provider business mailing address

237 N SANBORN AVE
JEFFERSON WI
53549-1226
US

V. Phone/Fax

Practice location:
  • Phone: 262-472-1300
  • Fax: 262-472-5608
Mailing address:
  • Phone: 920-674-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number52402030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: