Provider Demographics
NPI:1154198281
Name:FISHER, JOHN MERRITT (APRN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MERRITT
Last Name:FISHER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9423
Mailing Address - Country:US
Mailing Address - Phone:309-732-6991
Mailing Address - Fax:
Practice Address - Street 1:416 OAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9423
Practice Address - Country:US
Practice Address - Phone:309-732-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF11230148363LF0000X
ILF11230148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily