Basic Information
| Provider Information | |||||||||
| NPI: | 1710566104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | ALEXUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 COMMERCIAL AVE SW | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446639367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437605 | ||||||||
| FaxNumber: | 3303433542 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 COMMERCIAL AVE SW | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446639367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437605 | ||||||||
| FaxNumber: | 3303433542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0600X | 429966 | OH | N | Nursing Service Providers | Registered Nurse | Gerontology | 363LG0600X | 0031682 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.