Provider Demographics
NPI:1699847947
Name:FISHER, JENNIFER SAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 BEACON CT NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3469
Mailing Address - Country:US
Mailing Address - Phone:206-679-3558
Mailing Address - Fax:
Practice Address - Street 1:1814 BEACON CT NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3469
Practice Address - Country:US
Practice Address - Phone:206-679-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001167107163WC0200X
WARN60247840367500000X
VAAP60271083367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP60271083OtherLICENSE
WARN60247840OtherLICENSE