Provider Demographics
NPI:1629841879
Name:FISHER, ERICKA BROOKE
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:BROOKE
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 1:33 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2106
Mailing Address - Country:US
Mailing Address - Phone:276-337-1268
Mailing Address - Fax:
Practice Address - Street 1:33 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2106
Practice Address - Country:US
Practice Address - Phone:276-337-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program