Provider Demographics
NPI:1083081764
Name:FISHER, LISA (RNC-OB, IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:RNC-OB, IBCLC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CASAGRANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:3401 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6332
Mailing Address - Country:US
Mailing Address - Phone:580-250-5253
Mailing Address - Fax:580-585-5478
Practice Address - Street 1:3401 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6332
Practice Address - Country:US
Practice Address - Phone:580-250-5253
Practice Address - Fax:580-585-5478
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR118458163W00000X
OK11245984163WL0100X
OKFIS1-0436-5673163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient