Provider Demographics
NPI:1164722518
Name:FISCHER, BRENDA S (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:FISCHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 UPPER PRAIRIE DOG RD
Mailing Address - Street 2:
Mailing Address - City:BANNER
Mailing Address - State:WY
Mailing Address - Zip Code:82832-9732
Mailing Address - Country:US
Mailing Address - Phone:307-259-2434
Mailing Address - Fax:
Practice Address - Street 1:1401 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2705
Practice Address - Country:US
Practice Address - Phone:307-675-2667
Practice Address - Fax:307-675-2668
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9206.1081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner