Provider Demographics
NPI:1790044667
Name:SCHLOMER, PEGGY ANN (RNFA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:SCHLOMER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:ANN
Other - Last Name:SEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 S LEMAY AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524
Mailing Address - Country:US
Mailing Address - Phone:970-495-7421
Mailing Address - Fax:970-495-7424
Practice Address - Street 1:1107 S LEMAY AVE
Practice Address - Street 2:STE 240
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3960
Practice Address - Country:US
Practice Address - Phone:970-495-7421
Practice Address - Fax:970-495-7424
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO119373163W00000X
CO1546163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96481285Medicaid