Healthcare Provider Details

I. General information

NPI: 1114619285
Provider Name (Legal Business Name): TABITHA M FISHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST
OLEAN NY
14760-1598
US

IV. Provider business mailing address

515 MAIN ST
OLEAN NY
14760-1598
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-4127
  • Fax: 716-375-6096
Mailing address:
  • Phone: 716-375-4127
  • Fax: 716-375-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number490249-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: