Healthcare Provider Details

I. General information

NPI: 1730478801
Provider Name (Legal Business Name): KATHRYN MARIE FISHER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 14TH ST 202
LYNDEN WA
98264-2004
US

IV. Provider business mailing address

211 S 14TH ST 202
LYNDEN WA
98264-2004
US

V. Phone/Fax

Practice location:
  • Phone: 360-305-9761
  • Fax:
Mailing address:
  • Phone: 360-305-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC10081799
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60049490
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: