Provider Demographics
NPI:1063147551
Name:FISHER MOBILE AUDIOLOGY
Entity type:Organization
Organization Name:FISHER MOBILE AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:208-340-1482
Mailing Address - Street 1:1809 S GLASGOW AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-4853
Mailing Address - Country:US
Mailing Address - Phone:208-340-1482
Mailing Address - Fax:
Practice Address - Street 1:1809 S GLASGOW AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-4853
Practice Address - Country:US
Practice Address - Phone:208-340-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty