Individual
TERRA FISK
Active
Individual
TERRA FISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0000000023
MT
310400000X
Assisted Living Facility
000000023
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001616496
API
MT
05
—
0001616496
—
MT
Enumeration date
11/02/2022
Last updated
11/02/2022
Update your record
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