Basic Information
| Provider Information | |||||||||
| NPI: | 1407869498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16901 LAKESIDE HILLS CT | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681302318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8555244001 | ||||||||
| FaxNumber: | 4027177340 | ||||||||
| Practice Location | |||||||||
| Address1: | 16901 LAKESIDE HILLS CT | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8555244001 | ||||||||
| FaxNumber: | 4027177340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22530 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD-45123 | IA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 22530 | NE | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1407869498 | 05 | IA | MEDICAID | 470687317-16 | 05 | NE | MEDICAID |