Healthcare Provider Details

I. General information

NPI: 1568451599
Provider Name (Legal Business Name): PEGGY CUDERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 EVANS AVE SUITE 303
FT MYERS FL
33901-9322
US

IV. Provider business mailing address

4048 EVANS AVE SUITE 303
FT MYERS FL
33901-9322
US

V. Phone/Fax

Practice location:
  • Phone: 239-332-5344
  • Fax: 239-332-7246
Mailing address:
  • Phone: 239-332-5344
  • Fax: 239-332-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2787902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: