Provider Demographics
NPI:1417105081
Name:FISHER, COLLEEN YVONNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:YVONNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 U.S. HIGHWAY 22 WEST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45113
Mailing Address - Country:US
Mailing Address - Phone:937-302-9230
Mailing Address - Fax:937-289-4236
Practice Address - Street 1:9014 STATE ROUTE 3 WEST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45113
Practice Address - Country:US
Practice Address - Phone:937-302-9230
Practice Address - Fax:937-289-4236
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN188503163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse