Provider Demographics
NPI:1164498952
Name:FISHMAN, DONALD L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:L
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2520 RIVENDELL DR
Mailing Address - Street 2:DONALD L. FISHMAN, PSC
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-7409
Mailing Address - Country:US
Mailing Address - Phone:270-821-0608
Mailing Address - Fax:
Practice Address - Street 1:2520 RIVENDELL DR
Practice Address - Street 2:DONALD L. FISHMAN, PSC
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-7409
Practice Address - Country:US
Practice Address - Phone:270-821-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1037631163W00000X
KY546A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse