MEDICARE: DR. JANE S.R. FISHER PH.D.

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	103TC0700X	Clinical Psychologist	PSY-493	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B718-3	OTHER	HI	HMSA PIN
3	PSY493	OTHER	HI	MDX PIN

General Provider Information

NPI Number	:	1902894140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE S.R. FISHER PH.D.

Provider Business Mailing Address
First Line	:	1188 BISHOP ST
Second Line	:	SUITE 2302
City	:	HONOLULU
State	:	HI
Zip	:	96813-3301
Country	:	US
Telephone Number	:	808-524-3398
Fax Number	:	808-524-3398

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST
Second Line	:	SUITE 2302
City	:	HONOLULU
State	:	HI
Zip	:	96813-3301
Country	:	US
Telephone Number	:	808-524-3398
Fax Number	:	808-524-3398

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/29/2014

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