Provider Demographics
NPI:1346206158
Name:FISHER, CHRISTIAN THOR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:THOR
Last Name:FISHER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LINCOLN CIRCLE SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041
Mailing Address - Country:US
Mailing Address - Phone:712-737-4984
Mailing Address - Fax:712-737-5291
Practice Address - Street 1:1000 LINCOLN CIRCLE SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041
Practice Address - Country:US
Practice Address - Phone:712-737-4984
Practice Address - Fax:712-737-5291
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA050984367500000X
IA5200771367500000X
IA093447367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210898Medicaid
I7534002OtherMEDICARE GROUP PTAN
IA0210898Medicaid