Basic Information
| Provider Information | |||||||||
| NPI: | 1326117102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1930 ALCOA HWY | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655446650 | ||||||||
| FaxNumber: | 8655446572 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 ALCOA HWY | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655446650 | ||||||||
| FaxNumber: | 8655446572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 41846 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
| ID | Type | State | Issuer | Description | 21081 | 01 | APN NUMBER | OTHER |