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

Table of content: DR. LADIA M KONZ MD (NPI 1841243409)

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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