Basic Information
| Provider Information | |||||||||
| NPI: | 1447229653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3232 COTTONWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607340504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3645 E MCLEOD RD | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762220 | ||||||||
| FaxNumber: | 3606767750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 11/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0811X | AP30002509 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Chronically Ill |
ID Information
| ID | Type | State | Issuer | Description | 9615139 | 05 | WA | MEDICAID | 1130AL | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8928924 | 01 | WA | DEPARTMENT OF L&I | OTHER |