Provider Demographics
NPI:1730478801
Name:FISHER, KATHRYN MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 14TH ST
Mailing Address - Street 2:202
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-2004
Mailing Address - Country:US
Mailing Address - Phone:360-305-9761
Mailing Address - Fax:
Practice Address - Street 1:211 S 14TH ST
Practice Address - Street 2:202
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-2004
Practice Address - Country:US
Practice Address - Phone:360-305-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60049490225700000X
WANC10081799376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide