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General NPI Number Information
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NPI Number | 1568449619
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Entity Type | Individual
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Provider Name | SUE ELLEN FISHER PHD, APRN
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Gender | Female
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2994 TOLCATE LN
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-1529
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Country | US
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Telephone | 801-278-4598
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Fax |
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Provider Business Mailing Address
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Address Line | 2994 TOLCATE LN
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-1529
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Country | US
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Telephone | 801-278-4598
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 1947254405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 194725-4405
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License Number State | UT
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