MEDICARE: COURTENAY FISHER FNTP, MRWP

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	171400000X	Health & Wellness Coach	BL016126-05-2019	SC

General Provider Information

NPI Number	:	1902680101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTENAY FISHER FNTP, MRWP

Provider Business Mailing Address
First Line	:	851 DUNHAM ST
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7591
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 DUNHAM ST
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7591
Country	:	US
Telephone Number	:	804-822-1051
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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