Provider Demographics
NPI:1083299408
Name:FISCHER, MOLLY KATHLEEN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:FISCHER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14561-9550
Mailing Address - Country:US
Mailing Address - Phone:131-569-0615
Mailing Address - Fax:
Practice Address - Street 1:6600 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541-9560
Practice Address - Country:US
Practice Address - Phone:607-869-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310085363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health