Provider Demographics
NPI:1205486198
Name:FISHER, SUSANNA (CNA)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 ROUND TABLE RD APT G
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8429
Mailing Address - Country:US
Mailing Address - Phone:980-200-0333
Mailing Address - Fax:
Practice Address - Street 1:2502 ROUND TABLE RD APT G
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8429
Practice Address - Country:US
Practice Address - Phone:980-200-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1878403OtherNC BUSINESS REGISTRY
NC468595OtherCNA