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General NPI Number Information
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NPI Number | 1467093682
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN FISHER RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 1066 YELLOWSTONE AVE APT 61
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City | POCATELLO
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State | ID
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Zip | 83201-4430
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Country | US
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Telephone | 208-406-2209
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6429
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Country | US
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Telephone | 208-523-1100
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-1063
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License Number State | ID
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