Provider Demographics
NPI:1063889285
Name:FISCHER, LECIA
Entity type:Individual
Prefix:
First Name:LECIA
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WASHITA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73062
Mailing Address - Country:US
Mailing Address - Phone:580-819-3551
Mailing Address - Fax:
Practice Address - Street 1:1001 WASHITA AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:OK
Practice Address - Zip Code:73062
Practice Address - Country:US
Practice Address - Phone:580-819-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK851171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor