Individual
MS. LACRETIA FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3901 CHRYSLER SERVICE DR, TOLAN PARK, DETROIT, MI 48201-2167
(313) 993-3434
(313) 993-3421
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING DEPARTMENT, TROY, MI 48083-1138
(313) 993-3434
(313) 993-3421
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704281509
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704281509
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3434247
—
MI
Enumeration date
02/11/2015
Last updated
08/04/2022
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