Provider Demographics
NPI:1114698065
Name:FISHER, MARY JORDAN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JORDAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JORDAN
Other - Last Name:EVERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:334 KERRY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8060
Mailing Address - Country:US
Mailing Address - Phone:740-502-9998
Mailing Address - Fax:
Practice Address - Street 1:334 KERRY PARK CIR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8060
Practice Address - Country:US
Practice Address - Phone:740-502-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care