DR. SUE ELLEN FISHER (NPI# 1568449619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568449619 |
| Entity Type | Individual |
| Full Name | DR. SUE ELLEN FISHER |
| Credential | PHD, APRN |
| Practice Address |
2994 Tolcate Ln Salt Lake City UT 84121-1529 |
| Practice Telephone | 8012784598 |
| Mailing Telephone | 8012784598 |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-12-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
1947254405 | UT | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
194725-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | DESERET MUTUAL | U002 262141 | 01 |
| UT | DEA | MF0116788 | 01 |
| UT | CHAMPUS | U009 942938348 | 01 |
| UT | EDUCATORS MUTUAL | U003 942938348F11 | 01 |
| UT | INTRMTN. HEALTH CARE | U006 107001404101 | 01 |
| Street Address |
2994 TOLCATE LN |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84121-1529 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407483522 | Kaitlyn Horne | Behavior Technician | 6910 S. Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-26 |
| 1952936387 | Jared Wells | Behavior Technician | 6910 S Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-05 |
| 1518591874 | Slc Plastic Surgery LLC | Plastic Surgery | 6686 Highland Drive, Cottonwood Heights, UT 84121 | 2020-02-26 |
| 1093273708 | Anna O'hearon | Counselor | New Roads Behavioral Health, 2450 Fort Union Blvd, Cottonwood Heights, UT 84121 | 2019-03-12 |
| 1053883181 | Charles Keller IIi | Pediatrics | 2198 S Yvonne Rd #344, Salt Lake City, UT 84121 | 2018-12-31 |
| 1669964516 | Marissa King | Specialist | 1141 E. 3900 S. Suite 150a, Salt Lake, UT 84121 | 2018-06-05 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1700315462 | Nelson & Tillmann Family Dentistry, PC | Dentist | 5872 S. 900 E. Ste 202, Salt Lake City, UT 84121 | 2017-06-07 |
| 1912430588 | Wasatch Midwifery and Wellness, LLC | Dietitian, Registered | 6440 S Wasatch Blvd, Ste 140, Holladay, UT 84121 | 2017-04-10 |
| 1407308331 | Tina Polgar | Registered Nurse | 6244 Highland Drive, Murray, UT 84121 | 2016-10-26 |
| Find all providers in zip 84121 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114536737 | Bradley Martin | Nurse Practitioner | 31 M St Apt 110, Salt Lake City, UT 84103-3846 | 2020-07-29 |
| 1245877448 | Carla Lucile Applegate-anderson | Nurse Practitioner | 2666 South 2000 East, Suite 101, Salt Lake City, UT 84109 | 2019-12-06 |
| 1720433196 | Lillian Farris | Nurse Practitioner | 2180 E 4500 S Ste 125, Salt Lake City, UT 84117-4021 | 2016-05-04 |
| 1164816922 | Brittany Talbot | Nurse Practitioner | Salt Lake City Vamc, 500 Foothill Dr, Salt Lake City, UT 84148-0001 | 2015-03-19 |
| 1376959023 | Charleen Angell Aprn, Pllc | Nurse Practitioner | 145 S 400 E, Salt Lake City, UT 84111-2104 | 2014-07-02 |
| 1619390218 | Darin Ashton Principe | Nurse Practitioner | 159 W Broadway Ste 200, Salt Lake City, UT 84101-1923 | 2014-02-03 |
| 1083052963 | Christina Elizabeth Burton | Nurse Practitioner | 1008 S 1100 E, Apt 6, Salt Lake City, UT 84105 | 2013-06-12 |
| 1124237011 | Maria Christina Paegle | Nurse Practitioner | 4659 Brookwood Dr, Salt Lake City, UT 84117-4909 | 2007-05-21 |
| 1558430389 | Grace Forsythe Phd Inc | Nurse Practitioner | 2046 Murray Holladay Rd, 103, Salt Lake City, UT 84117-5125 | 2006-11-07 |
| 1639279466 | Joann M Rolando | Nurse Practitioner | George E Wahlen Department of Veterans Affairs, Medical Center Va, Salt Lake City, UT 84148-0001 | 2006-09-22 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84121 |
Please comment or provide details below to improve the information on DR. SUE ELLEN FISHER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.