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General NPI Number Information
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NPI Number | 1124017405
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Entity Type | Individual
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Provider Name | STARR LYNN FISH REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 368 SHAWSWICK SCHOOL RD
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City | BEDFORD
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State | IN
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Zip | 47421-7373
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Country | US
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Telephone | 812-277-8840
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Fax | 812-277-8840
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Provider Business Mailing Address
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Address Line | 455 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5004
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Country | US
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Telephone | 812-335-2400
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Fax | 812-335-2405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 28113403A
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License Number State | IN
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