Provider Demographics
NPI:1780659342
Name:FISHER, DONNA R (CANP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:FISHER
Suffix:
Gender:F
Credentials:CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KUYKENDALL LANE
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836
Mailing Address - Country:US
Mailing Address - Phone:304-530-7755
Mailing Address - Fax:304-530-7756
Practice Address - Street 1:112 KUYKENDALL LANE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-530-7755
Practice Address - Fax:304-530-7756
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV23207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29582Medicare UPIN