Provider Demographics
NPI:1841397882
Name:FISHER, SUSAN L (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E. EVERGREEN ST.
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5056
Mailing Address - Country:US
Mailing Address - Phone:903-957-0279
Mailing Address - Fax:903-957-0279
Practice Address - Street 1:230 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5056
Practice Address - Country:US
Practice Address - Phone:903-957-0275
Practice Address - Fax:903-957-0279
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02442363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP21883Medicare UPIN