Provider Demographics
NPI:1821468448
Name:KNOWLES, PEGGY A (ARNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:KNOWLES
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-0728
Mailing Address - Country:US
Mailing Address - Phone:360-980-2441
Mailing Address - Fax:877-491-4990
Practice Address - Street 1:415 SE 177TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4201
Practice Address - Country:US
Practice Address - Phone:360-980-2441
Practice Address - Fax:877-491-4990
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60511802163W00000X
WAAP60605303363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse