Provider Demographics
NPI:1710713110
Name:FISHER, HALEY (STUDENT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HENNESSEY
Mailing Address - State:OK
Mailing Address - Zip Code:73742-9490
Mailing Address - Country:US
Mailing Address - Phone:405-853-1401
Mailing Address - Fax:
Practice Address - Street 1:321 W CHEROKEE AVE STE C
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5666
Practice Address - Country:US
Practice Address - Phone:580-297-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program