1861596983 NPI number — MARGARET ANN PEGGY OWEN FNP

Table of content: MARGARET ANN PEGGY OWEN FNP (NPI 1861596983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861596983 NPI number — MARGARET ANN PEGGY OWEN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWEN
Provider First Name:
MARGARET ANN
Provider Middle Name:
PEGGY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861596983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 DOYLE PARK DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95405-4558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-545-1300
Provider Business Mailing Address Fax Number:
707-545-0823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 DOYLE PARK DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95405-4558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-545-1300
Provider Business Practice Location Address Fax Number:
707-545-0823
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  6189 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 404425 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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