Provider Demographics
NPI:1144279845
Name:FISHER, J. MEREINDA (LM-CPM)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:MEREINDA
Last Name:FISHER
Suffix:
Gender:F
Credentials:LM-CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MADISON CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1254
Mailing Address - Country:US
Mailing Address - Phone:864-354-8166
Mailing Address - Fax:
Practice Address - Street 1:409 MADISON CREEK COURT
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-3726
Practice Address - Country:US
Practice Address - Phone:864-354-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLM0005Medicaid
SC08OtherSTATE LICENSE