Provider Demographics
NPI:1558545095
Name:FISHER, STACY CAROL (CMT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:CAROL
Last Name:FISHER
Suffix:
Gender:F
Credentials:CMT
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 864
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-0864
Mailing Address - Country:US
Mailing Address - Phone:208-695-7228
Mailing Address - Fax:
Practice Address - Street 1:6 WEST OWYHEE AVENUE
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628
Practice Address - Country:US
Practice Address - Phone:208-695-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath