Provider Demographics
NPI:1295138444
Name:FISHER, JENNIFER LEE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COUNTRY CLUB
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6036
Mailing Address - Country:US
Mailing Address - Phone:541-683-5001
Mailing Address - Fax:541-683-1422
Practice Address - Street 1:520 COUNTRY CLUB
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6036
Practice Address - Country:US
Practice Address - Phone:541-683-5001
Practice Address - Fax:541-683-1422
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
ORPA170065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678680Medicaid