MEDICARE: DIANN M FISHER PA

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	PA822	NV
2	363A00000X	Physician Assistant	10499	MN

General Provider Information

NPI Number	:	1639212962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANN M FISHER PA

Provider Business Mailing Address
First Line	:	9200 PENN AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-2319
Country	:	US
Telephone Number	:	612-226-6929
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 CENTRAL AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3710
Country	:	US
Telephone Number	:	612-781-1212
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/04/2014

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Directions to “ DIANN M FISHER PA” Practice Location

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