Provider Demographics
NPI:1588438352
Name:FISHER, MALLORE RYANE (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:MALLORE
Middle Name:RYANE
Last Name:FISHER
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 MORNING BROOK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3324
Mailing Address - Country:US
Mailing Address - Phone:121-076-9529
Mailing Address - Fax:
Practice Address - Street 1:3214 MORNING BROOK ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3324
Practice Address - Country:US
Practice Address - Phone:210-769-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20233766P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide