Provider Demographics
NPI:1629260112
Name:MILLER, PEGGY SUZANNE (RN, ARNP-FNP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUZANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, ARNP-FNP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:SUZANNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8212 S MARCH POINT RD
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8684
Mailing Address - Country:US
Mailing Address - Phone:360-588-2800
Mailing Address - Fax:
Practice Address - Street 1:8212 S MARCH POINT RD
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8684
Practice Address - Country:US
Practice Address - Phone:360-588-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURN20R32363LF0000X
GU20R32-20NP01363LF0000X
IDNP229A363LF0000X
GUAPRN20NP363LF0000X
WAAP30001789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806291300Medicaid
WARN00081211Medicaid
WAAP3001789Medicaid