Provider Demographics
NPI:1780828012
Name:FISHER, JULIE ANN (LPN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:NY
Mailing Address - Zip Code:14430-0583
Mailing Address - Country:US
Mailing Address - Phone:585-286-0775
Mailing Address - Fax:
Practice Address - Street 1:8455 RIDGE RD
Practice Address - Street 2:APT 7A
Practice Address - City:CLARKSON
Practice Address - State:NY
Practice Address - Zip Code:14430
Practice Address - Country:US
Practice Address - Phone:585-286-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244761-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse