Provider Demographics
NPI:1124322078
Name:FISHER, BARBARA CARLENE
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:CARLENE
Last Name:FISHER
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 1:419 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2729
Mailing Address - Country:US
Mailing Address - Phone:660-826-5353
Mailing Address - Fax:660-826-5780
Practice Address - Street 1:419 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2729
Practice Address - Country:US
Practice Address - Phone:660-826-5353
Practice Address - Fax:660-826-5780
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO038775310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility