Provider Demographics
NPI:1770679516
Name:FISHER, ELEANOR ANNE (CNM)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:ANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15716 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-3958
Mailing Address - Country:US
Mailing Address - Phone:301-384-9411
Mailing Address - Fax:202-741-2550
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2500
Practice Address - Fax:202-741-2550
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN54929367A00000X
MDR093229367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR093229OtherSTATE LICENSE
DCRN54929OtherDC LICENSE
10744352OtherCAQH