Provider Demographics
NPI:1457505026
Name:PETERSON, PEGGY SUE (CPM,RM)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CPM,RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 COUNTRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-6716
Mailing Address - Country:US
Mailing Address - Phone:303-638-6934
Mailing Address - Fax:
Practice Address - Street 1:14300 COUNTRY HILLS DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-6716
Practice Address - Country:US
Practice Address - Phone:303-638-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR-106176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife