Provider Demographics
NPI:1023066610
Name:FISHER, MAUREEN JANET (PAC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:JANET
Last Name:FISHER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:PIERCE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4230 HAMILTON BLVD
Mailing Address - Street 2:URGENT CARE NORTH SIDE
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104
Mailing Address - Country:US
Mailing Address - Phone:712-224-5550
Mailing Address - Fax:
Practice Address - Street 1:4230 HAMILTON BLVD
Practice Address - Street 2:URGENT CARE NORTH SIDE
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:712-224-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-18
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-18
Provider Licenses
StateLicense IDTaxonomies
NE694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP35399Medicare UPIN
8HZ974Medicare ID - Type Unspecified