Provider Demographics
NPI:1902195704
Name:FISH, ANTHONY W (ARNP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:W
Last Name:FISH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2112
Mailing Address - Country:US
Mailing Address - Phone:319-861-7860
Mailing Address - Fax:319-861-7862
Practice Address - Street 1:600 7TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2112
Practice Address - Country:US
Practice Address - Phone:319-861-7860
Practice Address - Fax:319-861-7862
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA095431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily