Provider Demographics
NPI:1336981745
Name:FISH, MARY CATHERINE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:FISH
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 1:1101 HAYNER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2413
Mailing Address - Country:US
Mailing Address - Phone:575-635-9449
Mailing Address - Fax:
Practice Address - Street 1:1101 HAYNER AVE APT 1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2413
Practice Address - Country:US
Practice Address - Phone:575-635-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula