MEDICARE: AMY FISHER RDN, CN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	37001773A	IN

General Provider Information

NPI Number	:	1225473895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY FISHER RDN, CN

Provider Business Mailing Address
First Line	:	3337 COVINGTON ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3337 COVINGTON ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1187
Country	:	US
Telephone Number	:	765-414-0066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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