Provider Demographics
NPI:1578951208
Name:FISHER, DESIREE (RN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:HALSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4349 STATE HIGHWAY 7 LOT 10
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3527
Mailing Address - Country:US
Mailing Address - Phone:607-267-8006
Mailing Address - Fax:
Practice Address - Street 1:4349 STATE HIGHWAY 7 LOT 10
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3527
Practice Address - Country:US
Practice Address - Phone:607-267-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648043-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse