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General NPI Number Information
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NPI Number | 1629551098
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Entity Type | Individual
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Provider Name | ALYSIA MAE FISHER RDH
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 601 STATE ROAD 35
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City | CENTURIA
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State | WI
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Zip | 54824-9014
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Country | US
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Telephone | 715-646-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 1446 243RD AVE
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City | LUCK
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State | WI
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Zip | 54853-6000
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 10140-16
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License Number State | WI
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