Healthcare Provider Details

I. General information

NPI: 1427715382
Provider Name (Legal Business Name): ADRIONNA FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2021
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 WARNER ST
KENSINGTON MD
20895-4059
US

IV. Provider business mailing address

4223 WARNER ST
KENSINGTON MD
20895-4059
US

V. Phone/Fax

Practice location:
  • Phone: 808-265-0558
  • Fax:
Mailing address:
  • Phone: 808-265-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: