Provider Demographics
NPI:1487610606
Name:FISHER, KAREN LOUISE (ANP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:FISHER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:MAIN BUILDING 6TH FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-8362
Mailing Address - Fax:401-444-8366
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:MAIN BUILDING 6TH FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-8362
Practice Address - Fax:401-444-8366
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37545363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINPP37545OtherPROFESSIONAL LICENSE
RINPP37545OtherPROFESSIONAL LICENSE
NCS52068Medicare UPIN