Provider Demographics
NPI:1407861172
Name:THOMPSON, PEGGY J (CNM)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:J
Other - Last Name:DUNLOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1608 S J ST FL 1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7501
Mailing Address - Fax:360-825-6536
Practice Address - Street 1:1608 S J ST FL 1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7501
Practice Address - Fax:360-825-6536
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005979363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194346OtherSTATE L&I
WA8938491OtherSTATE CRIME VICTIMS
WA1044070Medicaid
WA0204598OtherSTATE L&I
WA8940535OtherSTATE CRIME VICTIMS
WAP81811Medicare UPIN
WA0204598OtherSTATE L&I
WAG8857946Medicare PIN
WAG8857946Medicare PIN