Provider Demographics
NPI:1508245556
Name:FISHER, KAIULANI
Entity Type:Individual
Prefix:
First Name:KAIULANI
Middle Name:
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 1:715 HORIZON DR
Mailing Address - Street 2:STE 225
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8700
Mailing Address - Country:US
Mailing Address - Phone:970-683-7107
Mailing Address - Fax:970-683-7167
Practice Address - Street 1:439 BREEZE ST
Practice Address - Street 2:STE 200
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2650
Practice Address - Country:US
Practice Address - Phone:970-824-6541
Practice Address - Fax:970-824-0313
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator