Provider Demographics
NPI:1932612314
Name:FISCHER, ANNA JEAN ENSTAD (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:JEAN ENSTAD
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:JEAN
Other - Last Name:ENSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3817 GEORGIA AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1563
Mailing Address - Country:US
Mailing Address - Phone:507-402-0566
Mailing Address - Fax:
Practice Address - Street 1:3817 GEORGIA AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427-1563
Practice Address - Country:US
Practice Address - Phone:507-402-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12580363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical