Individual
DR. SUE ELLEN FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, APRN
Contact information
Practice address
2994 TOLCATE LN, SALT LAKE CITY, UT 84121-1529
(801) 278-4598
Mailing address
2994 TOLCATE LN, SALT LAKE CITY, UT 84121-1529
(801) 278-4598
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
1947254405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
194725-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U002 262141
DESERET MUTUAL
UT
01
—
U003 942938348F11
EDUCATORS MUTUAL
UT
01
—
U006 107001404101
INTRMTN. HEALTH CARE
UT
01
—
U009 942938348
CHAMPUS
UT
Enumeration date
12/29/2005
Last updated
03/07/2023
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