Provider Demographics
NPI:1821524653
Name:FISH, KARI
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:311 S 4TH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4792
Mailing Address - Country:US
Mailing Address - Phone:701-795-3895
Mailing Address - Fax:701-795-3838
Practice Address - Street 1:311 S 4TH ST STE 119
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4792
Practice Address - Country:US
Practice Address - Phone:701-795-3895
Practice Address - Fax:701-795-3838
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator