Individual
FISHER WADLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
534 MAPLE VALLEY DR, FARMINGTON, MO 63640-1981
(573) 760-8253
Mailing address
555 W PINE ST, FARMINGTON, MO 63640-1439
(573) 747-1510
(573) 474-1512
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2024010299
MO
363LF0000X
Family Nurse Practitioner
Primary
2024010299
MO
Other
Enumeration date
03/05/2024
Last updated
09/19/2025
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