Healthcare Provider Details

I. General information

NPI: 1790892347
Provider Name (Legal Business Name): TERRI L FISHER RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE SUITET100
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

15984 W WATKINS ST
GOODYEAR AZ
85338-3410
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-5446
  • Fax:
Mailing address:
  • Phone: 928-310-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: