Provider Demographics
NPI:1588928238
Name:FISCHER, NICOLLE MARIE
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:MARIE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:
Other - Last Name:SPARAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-7190
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:SUITE 113
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6083
Practice Address - Country:US
Practice Address - Phone:515-232-3006
Practice Address - Fax:515-232-3009
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant