Provider Demographics
NPI:1992940399
Name:FISHER, JACQUELINE VICTORIA (RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:VICTORIA
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12615 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2503
Mailing Address - Country:US
Mailing Address - Phone:216-577-3965
Mailing Address - Fax:216-938-6270
Practice Address - Street 1:12615 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2503
Practice Address - Country:US
Practice Address - Phone:216-577-3965
Practice Address - Fax:216-938-6270
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-246269163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse