Provider Demographics
NPI:1841376472
Name:FISCHER, AMEETA (APRN-CRNA)
Entity type:Individual
Prefix:
First Name:AMEETA
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROSSLANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313
Mailing Address - Country:US
Mailing Address - Phone:304-776-4540
Mailing Address - Fax:304-388-3604
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-388-6220
Practice Address - Fax:304-388-3604
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36397163W00000X
WV39838367500000X
OHAPRN.CRNA.0020920367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0065013000Medicaid
WV430069464OtherRR MEDICARE