Provider Demographics
NPI:1487088209
Name:FISHER, NATHANAEL ALLEN BOYD
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:ALLEN BOYD
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39713 TROUSDALE RD
Mailing Address - Street 2:
Mailing Address - City:ASHER
Mailing Address - State:OK
Mailing Address - Zip Code:74826-3620
Mailing Address - Country:US
Mailing Address - Phone:585-319-6144
Mailing Address - Fax:
Practice Address - Street 1:39713 TROUSDALE RD
Practice Address - Street 2:
Practice Address - City:ASHER
Practice Address - State:OK
Practice Address - Zip Code:74826-3620
Practice Address - Country:US
Practice Address - Phone:585-319-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator