Provider Demographics
NPI:1396987749
Name:FISHER, AMANDA E (CST)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:FISHER
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 KEMP RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2567
Mailing Address - Country:US
Mailing Address - Phone:937-424-5825
Mailing Address - Fax:937-424-5829
Practice Address - Street 1:3359 KEMP RD STE 210
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2567
Practice Address - Country:US
Practice Address - Phone:937-424-5825
Practice Address - Fax:937-424-5829
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist