Provider Demographics
NPI:1376131276
Name:FISHBURNE, KIARA
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:FISHBURNE
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:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08603-0402
Mailing Address - Country:US
Mailing Address - Phone:609-456-5574
Mailing Address - Fax:
Practice Address - Street 1:24 KLAGG AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3438
Practice Address - Country:US
Practice Address - Phone:609-456-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula