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General NPI Number Information
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NPI Number | 1164176772
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Entity Type | Individual
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Provider Name | AMY FISHER PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 286 N GATEWAY DR STE 201
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City | PROVIDENCE
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State | UT
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Zip | 84332-5603
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Country | US
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Telephone | 435-932-6125
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Fax |
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Provider Business Mailing Address
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Address Line | 779 W 4800 S
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City | PRESTON
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State | ID
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Zip | 83263-5664
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Country | US
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Telephone | 602-361-6820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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