=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093101099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH FISHER M.S.N., R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2015
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94 LEWIS DR
-----------------------------------------------------
City | HAYS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67601-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-625-3257
-----------------------------------------------------
Fax | 785-625-8557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94 LEWIS DR
-----------------------------------------------------
City | HAYS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67601-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-625-3257
-----------------------------------------------------
Fax | 785-625-8557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 13-37929-112
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------