Provider Demographics
NPI:1760069173
Name:FISHER, MISCHELLE
Entity Type:Individual
Prefix:
First Name:MISCHELLE
Middle Name:
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 1:6327 US HIGHWAY 220 S
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-8312
Mailing Address - Country:US
Mailing Address - Phone:304-257-8955
Mailing Address - Fax:
Practice Address - Street 1:6327 US HIGHWAY 220 S
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8312
Practice Address - Country:US
Practice Address - Phone:304-257-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker