Provider Demographics
NPI:1598768871
Name:TOWLES, PEGGY (FNP-C)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:TOWLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N MONTEZUMA ST STE A
Mailing Address - Street 2:YOUR HEALTH CLINIC
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2066
Mailing Address - Country:US
Mailing Address - Phone:928-778-1566
Mailing Address - Fax:928-778-1366
Practice Address - Street 1:724 N MONTEZUMA ST STE A
Practice Address - Street 2:YOUR HEALTH CLINIC
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2066
Practice Address - Country:US
Practice Address - Phone:928-778-1566
Practice Address - Fax:928-778-1366
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-098748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP45152Medicare UPIN
UT005710903Medicare ID - Type Unspecified