Provider Demographics
NPI:1164966172
Name:FISHER, AMBER LEE (LAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AMBER LEE
Other - Middle Name:FISHER
Other - Last Name:TROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-1081
Mailing Address - Country:US
Mailing Address - Phone:970-730-3494
Mailing Address - Fax:970-788-7263
Practice Address - Street 1:224 GRAND AVE #4
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428
Practice Address - Country:US
Practice Address - Phone:970-730-3494
Practice Address - Fax:970-788-7263
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000.2323171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist