Individual
MARY SUSAN FISHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
900 HOSPITAL DR, MADISONVILLE, KY 42431-1644
(270) 825-5100
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-5100
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3000699
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044289
BCBS PIN
—
01
—
699A
LICENSE
KY
05
—
74349499
—
KY
Enumeration date
09/17/2006
Last updated
01/08/2015
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