Provider Demographics
NPI:1508528282
Name:SHARPE, PEGGY ALLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ALLENE
Last Name:SHARPE
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 1:986 BLUEBELL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7653
Mailing Address - Country:US
Mailing Address - Phone:805-550-2145
Mailing Address - Fax:
Practice Address - Street 1:986 BLUEBELL WAY
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7653
Practice Address - Country:US
Practice Address - Phone:805-550-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185151163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice