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General NPI Number Information
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NPI Number | 1417654500
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Entity Type | Individual
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Provider Name | SHANNON FISHER NP
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Gender | Female
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1259 LAKE PLAZA DR STE 270
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3560
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Country | US
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Telephone | 719-653-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 WINDMILL FLATS CT
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City | PEYTON
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State | CO
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Zip | 80831-7561
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Country | US
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Telephone | 720-980-2995
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APN.0998426-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0998426-NP
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License Number State | CO
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