Provider Demographics
NPI:1467567453
Name:FISHER, JOANNE MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MESA VERDE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2647
Mailing Address - Country:US
Mailing Address - Phone:707-642-8407
Mailing Address - Fax:
Practice Address - Street 1:3260 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4861
Practice Address - Country:US
Practice Address - Phone:415-473-4400
Practice Address - Fax:415-473-6855
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily