Provider Demographics
NPI:1225143423
Name:FISHER, JOSEPH D (CNP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 DRESSLER RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2784
Mailing Address - Country:US
Mailing Address - Phone:330-479-3333
Mailing Address - Fax:330-479-3334
Practice Address - Street 1:4048 DRESSLER RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2784
Practice Address - Country:US
Practice Address - Phone:330-479-3333
Practice Address - Fax:330-479-3334
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04950363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPPG GROUP NPI #
OH2551671OtherPPG MEDICAID GROUP #
OH2378172Medicaid
OH9338635OtherPPG MEDICARE GROUP #
OH2378172Medicaid
OHNP12653Medicare PIN