Provider Demographics
NPI:1730299215
Name:FISHMAN, LAURIE P (APN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:P
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2305
Mailing Address - Country:US
Mailing Address - Phone:702-733-4944
Mailing Address - Fax:
Practice Address - Street 1:3196 S MARYLAND PKWY
Practice Address - Street 2:SUITE 217
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2305
Practice Address - Country:US
Practice Address - Phone:702-733-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000893363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care