Provider Demographics
NPI:1710128285
Name:HAROLDSON, PEGGY ANN (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:HAROLDSON
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 1:826 E EUGIE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4825
Mailing Address - Country:US
Mailing Address - Phone:602-882-3115
Mailing Address - Fax:
Practice Address - Street 1:1811 SOUTH ALMA SCHOOL RD.
Practice Address - Street 2:STE. 160
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3003
Practice Address - Country:US
Practice Address - Phone:480-831-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN131991163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse