Provider Demographics
NPI:1346903002
Name:FISHER, CASSANDRA DANIELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DANIELLE
Last Name:FISHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BRIAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-8548
Mailing Address - Country:US
Mailing Address - Phone:814-977-3464
Mailing Address - Fax:
Practice Address - Street 1:195 MEMORIAL DR STE 3
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7056
Practice Address - Country:US
Practice Address - Phone:814-623-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner