Provider Demographics
NPI:1053721316
Name:FISHER, AUBRY (LAC)
Entity type:Individual
Prefix:MRS
First Name:AUBRY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4243
Mailing Address - Country:US
Mailing Address - Phone:312-434-8905
Mailing Address - Fax:
Practice Address - Street 1:1199 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4243
Practice Address - Country:US
Practice Address - Phone:312-434-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist