MEDICARE: ELIZABETH FISHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	109492	SC

General Provider Information

NPI Number	:	1396395588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FISHER

Provider Business Mailing Address
First Line	:	409 AIRY SPRINGS RD
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29642-8702
Country	:	US
Telephone Number	:	864-616-3962
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 AIRY SPRINGS RD
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29642-8702
Country	:	US
Telephone Number	:	864-616-3962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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