Provider Demographics
NPI:1407068398
Name:ENDRES, PEGGY M (CRNA)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:M
Last Name:ENDRES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 S EASTGATE CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1413
Mailing Address - Country:US
Mailing Address - Phone:509-456-4553
Mailing Address - Fax:
Practice Address - Street 1:5633 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1224
Practice Address - Country:US
Practice Address - Phone:509-482-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA-670367500000X
WAAP30004679367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8053187OtherIDAHO PROVIDER NUMBER
ID8053187OtherIDAHO PROVIDER NUMBER