Provider Demographics
NPI:1114072469
Name:FISHER, PEGGY SUE (FNP, CRNA)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUE
Last Name:FISHER
Suffix:
Gender:F
Credentials:FNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3302
Mailing Address - Country:US
Mailing Address - Phone:304-346-4455
Mailing Address - Fax:304-346-4457
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-346-4455
Practice Address - Fax:304-346-4457
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33518363LF0000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ18098Medicare UPIN