Provider Demographics
NPI:1932976107
Name:FISHER, KANDISE VIOLET
Entity type:Individual
Prefix:
First Name:KANDISE
Middle Name:VIOLET
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDISE
Other - Middle Name:VIOLET
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:NEY
Mailing Address - State:OH
Mailing Address - Zip Code:43549-0016
Mailing Address - Country:US
Mailing Address - Phone:419-438-1385
Mailing Address - Fax:
Practice Address - Street 1:402 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CECIL
Practice Address - State:OH
Practice Address - Zip Code:45821-9210
Practice Address - Country:US
Practice Address - Phone:419-438-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health