Provider Demographics
NPI:1285011692
Name:FISCHER, CHANDRA J (CPM, LM)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:J
Last Name:FISCHER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 W TISCHER RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1124
Mailing Address - Country:US
Mailing Address - Phone:612-387-7836
Mailing Address - Fax:
Practice Address - Street 1:3548 W TISCHER RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-1124
Practice Address - Country:US
Practice Address - Phone:612-387-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI298-49176B00000X
TX99283176B00000X
374J00000X
MN1081176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1081OtherMN BOARD OF MEDICAL PRACTICE
WI298-49OtherDEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
TX99283OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION