Provider Demographics
NPI:1417057183
Name:OBERG, PEGGY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:OBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PACIFIC AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4384
Mailing Address - Country:US
Mailing Address - Phone:970-576-8384
Mailing Address - Fax:
Practice Address - Street 1:1201 PACIFIC AVE STE 600
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:970-576-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550036NP363LF0000X
CA658563363LF0000X
CO115687363LF0000X
WAAP30006981 050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9651381Medicaid
WA9651381Medicaid
WA8862992Medicare PIN