1164654133 NPI number — MRS. JESSICA JEAN FISHER M.ED.

Table of content: MRS. JESSICA JEAN FISHER M.ED. (NPI 1164654133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164654133 NPI number — MRS. JESSICA JEAN FISHER M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
JESSICA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JURGENSEN
Provider Other First Name:
JESSICA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164654133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12547 W LISBON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL MIRAGE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85335-3182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-391-5653
Provider Business Mailing Address Fax Number:
623-932-7142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 E RILEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85323-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-932-7147
Provider Business Practice Location Address Fax Number:
623-932-7156
Provider Enumeration Date:
08/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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