Provider Demographics
NPI:1942373881
Name:FISHER, JOANNE M (NP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30000 S WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5753
Mailing Address - Country:US
Mailing Address - Phone:216-991-1403
Mailing Address - Fax:
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:STE 1002
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-991-2600
Practice Address - Fax:216-921-1389
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07824-NP363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP17431Medicare PIN