Provider Demographics
NPI:1477353043
Name:FISCHER, ELLIE ELIZABETH
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:ELIZABETH
Last Name:FISCHER
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 1:4735 FOXBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340-4611
Mailing Address - Country:US
Mailing Address - Phone:612-850-7045
Mailing Address - Fax:
Practice Address - Street 1:4735 FOXBERRY DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:MN
Practice Address - Zip Code:55340-4611
Practice Address - Country:US
Practice Address - Phone:612-850-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program