Provider Demographics
NPI:1043911738
Name:GIRONDE, PEGGY M
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:M
Last Name:GIRONDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 VANDENBURG RD APT 3423
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1685
Mailing Address - Country:US
Mailing Address - Phone:610-608-2442
Mailing Address - Fax:
Practice Address - Street 1:11400 SE 6TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6423
Practice Address - Country:US
Practice Address - Phone:610-608-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027267363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health