Individual
DIERDRE DENISE FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APRN, BC, CNSPMH
Contact information
Practice address
616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
(800) 257-8715
(800) 819-1655
Mailing address
1918 ENERO PARK, SAN ANTONIO, TX 78230-0934
(210) 694-0625
(800) 853-9536
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
627372
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148814002
—
TX
01
—
89N424
BLUE CROSS BLUE SHIELD
TX
01
—
P00108424
RAILROAD
TX
Enumeration date
07/03/2006
Last updated
07/08/2007
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