Provider Demographics
NPI:1699364257
Name:FISHER, GAIL P (RN: 850280)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:P
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN: 850280
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 PASSMORE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1716
Mailing Address - Country:US
Mailing Address - Phone:732-330-5036
Mailing Address - Fax:
Practice Address - Street 1:2921 PASSMORE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1716
Practice Address - Country:US
Practice Address - Phone:732-330-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850280163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse