Provider Demographics
NPI:1710231428
Name:FISHER, KATHERINE ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 NUUANU AVE
Mailing Address - Street 2:STE # 201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2427
Mailing Address - Country:US
Mailing Address - Phone:808-721-8342
Mailing Address - Fax:
Practice Address - Street 1:1834 NUUANU AVE
Practice Address - Street 2:STE # 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2427
Practice Address - Country:US
Practice Address - Phone:808-721-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist