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General NPI Number Information
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NPI Number | 1588421663
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Entity Type | Individual
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Provider Name | FISHER WADLOW FNP
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Gender | Male
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 534 MAPLE VALLEY DR
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City | FARMINGTON
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State | MO
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Zip | 63640-1981
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Country | US
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Telephone | 573-760-8253
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Fax |
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Provider Business Mailing Address
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Address Line | 555 W PINE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1439
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Country | US
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Telephone | 573-747-1510
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Fax | 573-474-1512
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024010299
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2024010299
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License Number State | MO
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