Provider Demographics
NPI:1194845065
Name:FISHER, CYNTHIA SUE, BATA (RD)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUE, BATA
Last Name:FISHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9401
Mailing Address - Country:US
Mailing Address - Phone:615-509-8672
Mailing Address - Fax:615-672-3494
Practice Address - Street 1:1010 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9401
Practice Address - Country:US
Practice Address - Phone:615-509-8672
Practice Address - Fax:615-672-3494
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00958Medicaid