MEDICARE: MOLLY FISCHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401841	NY

General Provider Information

NPI Number	:	1235625344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLLY FISCHER

Provider Business Mailing Address
First Line	:	4613 NORTH ST
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9499
Country	:	US
Telephone Number	:	315-751-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 NORTH ST
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9499
Country	:	US
Telephone Number	:	315-751-8711
Fax Number	:	833-469-8463

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	MOLLY FISCHER
Credential	:	NP
Telephone Number	:	315-751-8711

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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