Provider Demographics
NPI:1457106932
Name:FISHER, MARILYN JEAN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
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 1:5754 W BROWN RD
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9347
Mailing Address - Country:US
Mailing Address - Phone:937-473-2236
Mailing Address - Fax:
Practice Address - Street 1:1608 DOVER AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2722
Practice Address - Country:US
Practice Address - Phone:937-451-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health