Provider Demographics
NPI:1154097509
Name:FISHER, SARA JANE (NP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:FISHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2706
Mailing Address - Country:US
Mailing Address - Phone:812-238-4989
Mailing Address - Fax:
Practice Address - Street 1:7500 STATE ROAD 46 E
Practice Address - Street 2:
Practice Address - City:RILEY
Practice Address - State:IN
Practice Address - Zip Code:47871-7809
Practice Address - Country:US
Practice Address - Phone:812-894-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011463A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily