Provider Demographics
NPI:1528775707
Name:FISHER, PEGGY SUE (MS)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22445 SW CHILKAT TER
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9081
Mailing Address - Country:US
Mailing Address - Phone:503-683-3380
Mailing Address - Fax:
Practice Address - Street 1:22445 SW CHILKAT TER
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9081
Practice Address - Country:US
Practice Address - Phone:503-683-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist