Provider Demographics
NPI:1275142945
Name:FISHER-MEDFORD, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FISHER-MEDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 SHAMBLIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:GIVEN
Mailing Address - State:WV
Mailing Address - Zip Code:25245-8007
Mailing Address - Country:US
Mailing Address - Phone:304-532-9633
Mailing Address - Fax:
Practice Address - Street 1:3970 SHAMBLIN RUN RD
Practice Address - Street 2:
Practice Address - City:GIVEN
Practice Address - State:WV
Practice Address - Zip Code:25245-8007
Practice Address - Country:US
Practice Address - Phone:304-532-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant