Provider Demographics
NPI:1275298739
Name:FISHER, KRISTA EILEEN (RN, DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:EILEEN
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN, DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-9259
Mailing Address - Country:US
Mailing Address - Phone:717-381-7421
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN593347367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered