Healthcare Provider Details

I. General information

NPI: 1336197375
Provider Name (Legal Business Name): MEREDITH FISHER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FOURTH ST. BUILDING 166
FT IRWIN CA
92310
US

IV. Provider business mailing address

5294B BADGER LN
FORT IRWIN CA
92310-2201
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3185
  • Fax:
Mailing address:
  • Phone: 760-386-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN068180
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: