Provider Demographics
NPI:1124017405
Name:FISH, STARR LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STARR
Middle Name:LYNN
Last Name:FISH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:STARR
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:455 S LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5004
Mailing Address - Country:US
Mailing Address - Phone:812-335-2400
Mailing Address - Fax:812-335-2405
Practice Address - Street 1:368 SHAWSWICK SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-7373
Practice Address - Country:US
Practice Address - Phone:812-277-8840
Practice Address - Fax:812-277-8840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28113403A372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider