Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1558545095 |
---|---|
Provider Name | Mrs. Stacy Carol Fisher |
First Address | Homedale, ID 83628-0864 |
Second Address | Homedale, ID 83628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |