Provider Demographics
NPI:1053746735
Name:FISCHER KING, JENIFER LIZ (RN)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:LIZ
Last Name:FISCHER KING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JENIFER
Other - Middle Name:LIZ
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1450 GARDEN BROOK ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-6420
Mailing Address - Country:US
Mailing Address - Phone:949-201-7799
Mailing Address - Fax:
Practice Address - Street 1:1450 GARDEN BROOK ST UNIT B
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-6420
Practice Address - Country:US
Practice Address - Phone:949-201-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA812523163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care