Provider Demographics
NPI:1497156574
Name:DAVIDSON, PEGGY (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 SIGNAL WAY
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2237
Mailing Address - Country:US
Mailing Address - Phone:541-297-2001
Mailing Address - Fax:
Practice Address - Street 1:876 SIGNAL WAY
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2237
Practice Address - Country:US
Practice Address - Phone:541-297-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083037624RN163W00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse