Provider Demographics
NPI:1790796704
Name:BRIGGS, PEGGY JAN (ARNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JAN
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22007 MERIDIAN AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8412
Mailing Address - Country:US
Mailing Address - Phone:253-780-4930
Mailing Address - Fax:253-375-6842
Practice Address - Street 1:22007 MERIDIAN AVE E STE C
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338
Practice Address - Country:US
Practice Address - Phone:253-780-4930
Practice Address - Fax:253-375-6842
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521048363L00000X
WAAP60327305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D5942Medicare PIN
TXS37660Medicare UPIN