Provider Demographics
NPI:1588339329
Name:FISHER, CYNTHIA ANNE
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:HALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31626 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9360
Mailing Address - Country:US
Mailing Address - Phone:541-942-9059
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE STE 228
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1803
Practice Address - Country:US
Practice Address - Phone:800-525-6800
Practice Address - Fax:503-581-0043
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105228172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker