Provider Demographics
NPI:1114391117
Name:FISHER, JACLYN MICHELE
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:MICHELE
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 LINCOLNVIEW ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3240
Mailing Address - Country:US
Mailing Address - Phone:248-703-2721
Mailing Address - Fax:
Practice Address - Street 1:3067 LINCOLNVIEW ST
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3240
Practice Address - Country:US
Practice Address - Phone:248-703-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula