1023066610 NPI number — MRS. MAUREEN JANET FISHER PAC

Table of content: MRS. MAUREEN JANET FISHER PAC (NPI 1023066610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023066610 NPI number — MRS. MAUREEN JANET FISHER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
MAUREEN
Provider Middle Name:
JANET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHER
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
PIERCE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023066610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
07/18/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4230 HAMILTON BLVD
Provider Second Line Business Mailing Address:
URGENT CARE NORTH SIDE
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-224-5550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 HAMILTON BLVD
Provider Second Line Business Practice Location Address:
URGENT CARE NORTH SIDE
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-224-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

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: 363AM0700X , with the licence number:  694 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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