Provider Demographics
NPI:1013388958
Name:FISCHER, PEGGY O (NP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:O
Last Name:FISCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 S REDWOOD RD # STC035
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-3145
Mailing Address - Country:US
Mailing Address - Phone:801-957-4268
Mailing Address - Fax:
Practice Address - Street 1:4600 S REDWOOD RD # STC035
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-3145
Practice Address - Country:US
Practice Address - Phone:801-957-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12726068-4405363LF0000X
IN71005954A363L00000X
IN28112810A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN187720029OtherMEDICARE
IN201337020Medicaid
INP01726912OtherRR MEDICARE