Provider Demographics
NPI:1336152040
Name:WILLIAMSON, PEGGY ANN (APN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:STE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:975 RYLAND
Practice Address - Street 2:SUITE 105
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-982-5640
Practice Address - Fax:775-982-5724
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV APN 275363L00000X
NVAPN00275367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336152040Medicaid
11974226OtherCAQH
NVCC954ZMedicare PIN