Provider Demographics
NPI:1316704521
Name:FISHER, NICHOLE GENINE
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:GENINE
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 PEARL RD APT 224
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3038
Mailing Address - Country:US
Mailing Address - Phone:216-703-0010
Mailing Address - Fax:216-675-4546
Practice Address - Street 1:6260 PEARL RD APT 224
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3038
Practice Address - Country:US
Practice Address - Phone:216-703-0010
Practice Address - Fax:216-675-4546
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health