1447229653 NPI number — PEGGY A ALLEN ARNP

Table of content: PEGGY A ALLEN ARNP (NPI 1447229653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447229653 NPI number — PEGGY A ALLEN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
PEGGY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1447229653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3232 COTTONWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-734-0504
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3645 E MCLEOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-676-2220
Provider Business Practice Location Address Fax Number:
360-676-7750
Provider Enumeration Date:
03/17/2006

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: 364SP0811X , with the licence number:  AP30002509 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9615139 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1130AL . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8928924 . This is a "DEPARTMENT OF L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".