Provider Demographics
NPI:1699753905
Name:FISHER, DEBORA J (PA-C)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:J
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4508
Mailing Address - Country:US
Mailing Address - Phone:814-944-7109
Mailing Address - Fax:
Practice Address - Street 1:1800 GRANT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4508
Practice Address - Country:US
Practice Address - Phone:814-944-7109
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002710L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS84189Medicare UPIN
PA028656Medicare ID - Type Unspecified