1336323260 NPI number — MISS AMANDA AUDREY FISCHER CNA

Table of content: MISS AMANDA AUDREY FISCHER CNA (NPI 1336323260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336323260 NPI number — MISS AMANDA AUDREY FISCHER CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCHER
Provider First Name:
AMANDA
Provider Middle Name:
AUDREY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336323260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 E ENTERPRISE AVE
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54913-7862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-731-6611
Provider Business Mailing Address Fax Number:
920-731-6732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 E ENTERPRISE AVE
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54913-7862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-731-6611
Provider Business Practice Location Address Fax Number:
920-731-6732
Provider Enumeration Date:
12/27/2007

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: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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