Healthcare Provider Details

I. General information

NPI: 1811878739
Provider Name (Legal Business Name): MARCIE LOUISE FISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASHINGTON ST
ELMIRA NY
14901-2849
US

IV. Provider business mailing address

38 W 6TH ST
CORNING NY
14830-3124
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-4700
  • Fax:
Mailing address:
  • Phone: 607-737-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number564149-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: