Provider Demographics
NPI:1073753026
Name:HARRIS, PEGGY JOYCE (APRN)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:JOYCE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2523 E GARFIELD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4989
Mailing Address - Country:US
Mailing Address - Phone:307-460-9888
Mailing Address - Fax:307-460-9892
Practice Address - Street 1:2523 E GARFIELD ST
Practice Address - Street 2:SUITE B
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4989
Practice Address - Country:US
Practice Address - Phone:307-460-9888
Practice Address - Fax:307-460-9892
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY31377.1559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily