Healthcare Provider Details

I. General information

NPI: 1013388958
Provider Name (Legal Business Name): PEGGY O FISCHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S REDWOOD RD # STC035
SALT LAKE CITY UT
84123-3145
US

IV. Provider business mailing address

4600 S REDWOOD RD # STC035
SALT LAKE CITY UT
84123-3145
US

V. Phone/Fax

Practice location:
  • Phone: 801-957-4268
  • Fax:
Mailing address:
  • Phone: 801-957-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12726068-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: