Provider Demographics
NPI:1295859692
Name:FISHER, DIXIE ANN (CNP)
Entity Type:Individual
Prefix:MS
First Name:DIXIE
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 DARIUS LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1866
Mailing Address - Country:US
Mailing Address - Phone:209-499-0934
Mailing Address - Fax:
Practice Address - Street 1:1420 W H ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361
Practice Address - Country:US
Practice Address - Phone:209-848-5336
Practice Address - Fax:209-848-5338
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11965363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health