Provider Demographics
NPI:1831656651
Name:HOUGH (FISHER), AMANDA GAYLE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GAYLE
Last Name:HOUGH (FISHER)
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GAYLE
Other - Last Name:HOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:32 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-1226
Mailing Address - Country:US
Mailing Address - Phone:716-697-3862
Mailing Address - Fax:
Practice Address - Street 1:32 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-1226
Practice Address - Country:US
Practice Address - Phone:716-697-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse