Provider Demographics
NPI:1689289829
Name:FIECHTER, ANGELA SUE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:FIECHTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9016 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1718
Mailing Address - Country:US
Mailing Address - Phone:678-368-9254
Mailing Address - Fax:
Practice Address - Street 1:135 E RAY RD STE 7
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3376
Practice Address - Country:US
Practice Address - Phone:715-892-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN219182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN219182OtherRN