Provider Demographics
NPI:1497719561
Name:FISHER, MELISSA (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
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 1:8015 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4174
Mailing Address - Country:US
Mailing Address - Phone:410-255-0102
Mailing Address - Fax:410-255-0103
Practice Address - Street 1:8015 APPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4174
Practice Address - Country:US
Practice Address - Phone:410-255-0102
Practice Address - Fax:410-255-0103
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154370363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208799OtherJHHC PROVIDER NUMBER
MD888342-01OtherCAREFIRST MD RENDERING
MD8441180OtherAETNA HMO
MD410221500Medicaid
MD9649199OtherAETNA PPO
MD7605-0082OtherCAREFIRST BLUECHOICE
MDP00338934OtherRR MEDICARE
MD9649199OtherAETNA PPO
MD226LO286Medicare PIN