Provider Demographics
NPI:1801909031
Name:HANSEN, PEGGY ANN (MN, ARNP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 MUKILTEO SPEEDWAY
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3206
Mailing Address - Country:US
Mailing Address - Phone:425-356-6516
Mailing Address - Fax:425-356-6515
Practice Address - Street 1:8490 MUKILTEO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3206
Practice Address - Country:US
Practice Address - Phone:425-356-6516
Practice Address - Fax:425-356-6515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00076386163WG0000X
WAAP30001528364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR51948OtherPIN REGENCE BLUE SHIELD
WA106998100000OtherPIN PREMERA BLUE CROSS
WA1168333OtherVENDOR # CIGNA
WA169453OtherPROVID VALUE OPTIONS
WA3715-01OtherPROVIDER ID PROVIDENCE HP
WAA399010OtherVENDER # V.O. BOEING
WA0863362OtherPROVID AETNA HM INTX
WA1168333OtherVENDOR # CIGNA