Provider Demographics
NPI:1417220112
Name:FISHER, SUSANNE G
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:G
Last Name:FISHER
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 1:2106 NW ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3107
Mailing Address - Country:US
Mailing Address - Phone:580-284-4492
Mailing Address - Fax:
Practice Address - Street 1:2106 NW ASHLEY CT
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3107
Practice Address - Country:US
Practice Address - Phone:580-284-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor