Basic Information
| Provider Information | |||||||||
| NPI: | 1407950645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISCHER-KIERECKI | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FISCHER | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | A. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CNM | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1415 PORTLAND AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859224200 | ||||||||
| FaxNumber: | 5859224922 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 PORTLAND AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859224200 | ||||||||
| FaxNumber: | 5859224922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2006 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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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 | 367A00000X | 000730 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 01797126 | 05 | NY | MEDICAID |