Provider Demographics
NPI:1316286412
Name:FISCHER, IRENE M (LMP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:FISCHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1501 SUMMITVIEW AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2963
Mailing Address - Country:US
Mailing Address - Phone:509-654-4612
Mailing Address - Fax:
Practice Address - Street 1:2508 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5104
Practice Address - Country:US
Practice Address - Phone:509-966-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60185187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist