Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024174059 | VA |
NPI | 1013467307 |
---|---|
Provider Name | Amanda B Fisher |
First Address | Fredericksburg, VA 22401-5719 |
Second Address | Fredericksburg, VA 22401-5719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2016 |
Last Update Date | 11/10/2016 |