=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750172813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES WILLIAM FISHER AGACNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2025
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 EUCLID AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44195-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-444-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 956 NORTHWEST RD
-----------------------------------------------------
City | CASTALIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44824-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-440-4144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0039286
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------