Provider Demographics
NPI:1417266628
Name:FISHER, SHARON M
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
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 1:1011 17TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-355-5030
Mailing Address - Fax:
Practice Address - Street 1:2562 DURHAM DAYTON HWY
Practice Address - Street 2:APT A
Practice Address - City:DURHAM
Practice Address - State:CA
Practice Address - Zip Code:95938-9654
Practice Address - Country:US
Practice Address - Phone:530-513-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60175077172M00000X, 173C00000X, 174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist