Provider Demographics
NPI:1679229223
Name:FISHER FAMILY MEDICINE, PS
Entity Type:Organization
Organization Name:FISHER FAMILY MEDICINE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:FARINAS
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FNP-C
Authorized Official - Phone:907-382-9000
Mailing Address - Street 1:1290 SE PHILLIPS RD UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7614
Mailing Address - Country:US
Mailing Address - Phone:907-382-9000
Mailing Address - Fax:
Practice Address - Street 1:1020 ANDERSON DR STE 203
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-533-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care