Provider Demographics
NPI:1932135365
Name:FISHMAN, AMY (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3366 OAKDALE AVE N
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2948
Mailing Address - Country:US
Mailing Address - Phone:763-520-7989
Mailing Address - Fax:763-520-7989
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:SUITE 315
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-520-7989
Practice Address - Fax:763-520-7989
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN131742300Medicaid
MNE73322Medicare UPIN