Provider Demographics
NPI:1265701155
Name:FISHER, LORAINE A (FNP-C)
Entity type:Individual
Prefix:
First Name:LORAINE
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LORAINE
Other - Middle Name:A
Other - Last Name:RABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3740 EDISON LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3448
Mailing Address - Country:US
Mailing Address - Phone:574-252-4150
Mailing Address - Fax:
Practice Address - Street 1:3740 EDISON LAKES PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3448
Practice Address - Country:US
Practice Address - Phone:574-252-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003921A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704352599OtherAPRN LICENSE
IN201067440Medicaid
IN28081328AOtherRN LICENSE
IN71003921AOtherAPRN LICENSE
IN28081328AOtherRN LICENSE
IN71003921AOtherAPRN LICENSE