1679733638 NPI number — MRS. DANA MARIE FISCHER MA00024010

Table of content: MRS. DANA MARIE FISCHER MA00024010 (NPI 1679733638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679733638 NPI number — MRS. DANA MARIE FISCHER MA00024010

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCHER
Provider First Name:
DANA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA00024010
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OVERMAN
Provider Other First Name:
DANA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA00024010
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679733638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 12TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-2113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-770-6718
Provider Business Mailing Address Fax Number:
866-234-9871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2216 COMMERCIAL AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-293-0299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2008

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: 174400000X , with the licence number:  MA00024010 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA00024010 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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