Provider Demographics
NPI:1700819877
Name:BAKKER, PEGGY LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNN
Last Name:BAKKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:LYNN
Other - Last Name:WIDENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6720 S ADAMS WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1802
Mailing Address - Country:US
Mailing Address - Phone:303-813-7721
Mailing Address - Fax:
Practice Address - Street 1:131 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80129-1931
Practice Address - Country:US
Practice Address - Phone:303-798-0963
Practice Address - Fax:303-798-5069
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71475207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85205559Medicaid