Provider Demographics
NPI:1720342132
Name:FISHER, KATHERINE T
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:T
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 1:2905 CUYLERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9616
Mailing Address - Country:US
Mailing Address - Phone:585-880-4846
Mailing Address - Fax:
Practice Address - Street 1:2905 CUYLERVILLE RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NY
Practice Address - Zip Code:14481-9616
Practice Address - Country:US
Practice Address - Phone:585-880-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306234-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse