Provider Demographics
NPI:1891918686
Name:HALSEY, PEGGY JEAN (CDM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JEAN
Last Name:HALSEY
Suffix:
Gender:F
Credentials:CDM, CPM
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 874486
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4486
Mailing Address - Country:US
Mailing Address - Phone:907-841-2565
Mailing Address - Fax:888-862-1422
Practice Address - Street 1:2405 S. KNIK GOOSE BAY ROAD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-841-2565
Practice Address - Fax:888-862-1422
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK44176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022098Medicaid
AK44OtherSTATE LICENSE NUMBER
AKNM0044Medicaid