Provider Demographics
NPI:1306655287
Name:FISHER, BRENDA DEE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:DEE
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 1:28575 N BLACK CANYON HWY UNIT 1005
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0090
Mailing Address - Country:US
Mailing Address - Phone:602-206-4981
Mailing Address - Fax:
Practice Address - Street 1:28575 N BLACK CANYON HWY UNIT 1005
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0090
Practice Address - Country:US
Practice Address - Phone:602-206-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education