Provider Demographics
NPI:1245793322
Name:FISHER, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
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 1:12105 ROUTE 35 S
Mailing Address - Street 2:
Mailing Address - City:MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17058-7225
Mailing Address - Country:US
Mailing Address - Phone:717-402-1004
Mailing Address - Fax:
Practice Address - Street 1:12105 ROUTE 35 S
Practice Address - Street 2:
Practice Address - City:MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:17058-7225
Practice Address - Country:US
Practice Address - Phone:717-402-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010524367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife