Provider Demographics
NPI:1932675543
Name:FISHER, CARLA JEAN
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
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 1:3017 YORKTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2109
Mailing Address - Country:US
Mailing Address - Phone:504-355-6123
Mailing Address - Fax:
Practice Address - Street 1:3017 YORKTOWNE DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2109
Practice Address - Country:US
Practice Address - Phone:504-355-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver