MEDICARE: EMILY PAIGE FISHER-IVES

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1578225553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY PAIGE FISHER-IVES

Provider Business Mailing Address
First Line	:	6100 PAN AMERICAN EAST FWY NE STE 200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 PAN AMERICAN EAST FWY NE STE 200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3443
Country	:	US
Telephone Number	:	505-823-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	08/15/2023

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