Basic Information
| Provider Information | |||||||||
| NPI: | 1134454762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | JESS | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 S 16TH ST | ||||||||
| Address2: | APT 1 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181024412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137107016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1139 BEN FRANKLIN HWY W | ||||||||
| Address2: | |||||||||
| City: | DOUGLASSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195181850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103854444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA054140 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.