Provider Demographics
NPI:1114648540
Name:FISHER, CARLY KATRINE
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:KATRINE
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 DEAVER RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-4418
Mailing Address - Country:US
Mailing Address - Phone:410-925-2356
Mailing Address - Fax:
Practice Address - Street 1:391 DEAVER RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-4418
Practice Address - Country:US
Practice Address - Phone:410-925-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist