Provider Demographics
NPI:1679022164
Name:FISCHER, NATHAN (MS PA-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 E BASELINE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7288
Mailing Address - Country:US
Mailing Address - Phone:480-505-3276
Mailing Address - Fax:
Practice Address - Street 1:3048 E BASELINE RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7288
Practice Address - Country:US
Practice Address - Phone:480-505-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant