=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316998412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREIDA L FISHER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2006
-----------------------------------------------------
Last Update Date | 03/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 HEARTHSTONE CT STE 201
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19606-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-779-9550
-----------------------------------------------------
Fax | 610-779-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 BERNVILLE RD
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19605-9453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-378-2440
-----------------------------------------------------
Fax | 610-378-2441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | VP005540D
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------