Healthcare Provider Details

I. General information

NPI: 1225177850
Provider Name (Legal Business Name): AMY LUCILLE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W VIRGINIA ST
EVANSVILLE IN
47710-1742
US

IV. Provider business mailing address

PO BOX 3938
EVANSVILLE IN
47737-3938
US

V. Phone/Fax

Practice location:
  • Phone: 812-464-7816
  • Fax: 812-464-7811
Mailing address:
  • Phone: 812-464-7816
  • Fax: 812-464-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: