Provider Demographics
NPI:1336197375
Name:FISHER, MEREDITH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
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 1:5294B BADGER LN
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-2201
Mailing Address - Country:US
Mailing Address - Phone:760-386-1257
Mailing Address - Fax:
Practice Address - Street 1:FOURTH ST. BUILDING 166
Practice Address - Street 2:
Practice Address - City:FT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN068180164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse