Provider Demographics
NPI:1447229653
Name:ALLEN, PEGGY A (ARNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:ALLEN
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 1:3232 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1221
Mailing Address - Country:US
Mailing Address - Phone:360-734-0504
Mailing Address - Fax:
Practice Address - Street 1:3645 E MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8700
Practice Address - Country:US
Practice Address - Phone:360-676-2220
Practice Address - Fax:360-676-7750
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002509364SP0811X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0811XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Chronically Ill
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9615139Medicaid
WA1130ALOtherREGENCE BLUE SHIELD
WA8928924OtherDEPARTMENT OF L&I
S94858Medicare UPIN
WA9615139Medicaid