Provider Demographics
NPI:1508590373
Name:FISSCHER, OLIVIA KATE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KATE
Last Name:FISSCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHANDLER DR APT B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6078
Mailing Address - Country:US
Mailing Address - Phone:910-612-3761
Mailing Address - Fax:
Practice Address - Street 1:120 CHANDLER DR APT B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6078
Practice Address - Country:US
Practice Address - Phone:910-612-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant