Provider Demographics
NPI:1508006420
Name:PEGUES, BIRGITTE DARUM (RNFA)
Entity Type:Individual
Prefix:
First Name:BIRGITTE
Middle Name:DARUM
Last Name:PEGUES
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-1386
Mailing Address - Country:US
Mailing Address - Phone:719-572-1004
Mailing Address - Fax:719-572-1004
Practice Address - Street 1:106 OAKDALE DR
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-1386
Practice Address - Country:US
Practice Address - Phone:719-572-1004
Practice Address - Fax:719-572-1004
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO121657163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant