Provider Demographics
NPI:1528401213
Name:FISHER, JACQUELINE CHRISTINE (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:FISHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 KENWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2294
Mailing Address - Country:US
Mailing Address - Phone:513-393-9122
Mailing Address - Fax:513-715-0003
Practice Address - Street 1:8300 KENWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2294
Practice Address - Country:US
Practice Address - Phone:513-393-9122
Practice Address - Fax:513-715-0003
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34012957207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology