Individual
SHELLY DAWN FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-0111
Mailing address
PO BOX 171306, MEMPHIS, TN 38187-1306
(901) 725-5846
(901) 726-4827
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
103254
TN
367500000X
Certified Registered Nurse Anesthetist
758279
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA233008
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3629385
—
TN
01
—
49727
NATIONAL BOARD CERTIFICATION OF NURSE ANETHETIST
—
01
—
RNA233008
MAINE APRN LICENSE
ME
Enumeration date
05/23/2006
Last updated
07/17/2023
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