Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | KY4215 | KY |
NPI | 1174800601 |
---|---|
Provider Name | Mary June Fisk |
First Address | Louisville, KY 40204-1852 |
Second Address | Louisville, KY 40204-1852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2011 |
Last Update Date | 11/11/2011 |