Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | B1-0000294 | DE |
NPI | 1134286016 |
---|---|
Provider Name | Irene Fisher |
First Address | Wilmington, DE 19810-3644 |
Second Address | Wilmington, DE 19810-3644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000023583 | DELAWARE PHYSICIANS CARE (01) | DE |
R29326 | (02) | DE |