Provider Demographics
NPI:1427142215
Name:FISHER, KATHLEEN (CRNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9321 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54485-9797
Mailing Address - Country:US
Mailing Address - Phone:715-923-8845
Mailing Address - Fax:
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8360
Practice Address - Country:US
Practice Address - Phone:715-361-2000
Practice Address - Fax:715-361-2178
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124603367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103339622Medicaid
430036344OtherMEDICARE RAILROAD
WI43365500Medicaid
430036344OtherMEDICARE RAILROAD
MI103339622Medicaid