Provider Demographics
NPI:1770751166
Name:FISHER, MARIANNE (RD, LD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 BICKNELL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2921
Mailing Address - Country:US
Mailing Address - Phone:330-650-6296
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST BLVD
Practice Address - Street 2:ST 320
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4218
Practice Address - Country:US
Practice Address - Phone:330-564-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 3212133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered