Provider Demographics
NPI:1629270418
Name:FISHER-AVALOS, TIFFANY SHEREE (CNM)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHEREE
Last Name:FISHER-AVALOS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:SHEREE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:694 GOOD DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2433
Mailing Address - Country:US
Mailing Address - Phone:717-397-8177
Mailing Address - Fax:717-397-2426
Practice Address - Street 1:694 GOOD DR SUITE 112
Practice Address - Street 2:DRS MAY GRANT ASSOCIATES
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-397-8177
Practice Address - Fax:717-397-2426
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010151176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife