Healthcare Provider Details

I. General information

NPI: 1891918686
Provider Name (Legal Business Name): PEGGY JEAN HALSEY CDM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 S. KNIK GOOSE BAY ROAD
WASILLA AK
99654
US

IV. Provider business mailing address

PO BOX 874486
WASILLA AK
99687-4486
US

V. Phone/Fax

Practice location:
  • Phone: 907-841-2565
  • Fax: 888-862-1422
Mailing address:
  • Phone: 907-841-2565
  • Fax: 888-862-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number44
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1022098
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
Identifier44
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerSTATE LICENSE NUMBER
# 3
IdentifierNM0044
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: