Provider Demographics
NPI:1083782395
Name:FISCHER, MELINDA JO (RN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:JO
Last Name:FISCHER
Suffix:
Gender:F
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:JO
Other - Last Name:MISSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1111
Mailing Address - Country:US
Mailing Address - Phone:573-783-4111
Mailing Address - Fax:573-783-1096
Practice Address - Street 1:611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1111
Practice Address - Country:US
Practice Address - Phone:573-783-4111
Practice Address - Fax:573-783-1096
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO122378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP53608Medicare UPIN