Provider Demographics
NPI:1124659560
Name:FISH, LORI JEAN (RN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:FISH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:ME
Mailing Address - Zip Code:04282-3435
Mailing Address - Country:US
Mailing Address - Phone:207-713-6643
Mailing Address - Fax:207-224-0341
Practice Address - Street 1:24 MILL HILL RD
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282-3435
Practice Address - Country:US
Practice Address - Phone:207-713-6643
Practice Address - Fax:207-224-0341
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER26651163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health