Healthcare Provider Details

I. General information

NPI: 1114647708
Provider Name (Legal Business Name): PEGGY SCHWARTZ CHIPKIN RN, NP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 E BLITHEDALE AVE STE F
MILL VALLEY CA
94941-2060
US

IV. Provider business mailing address

158 E BLITHEDALE AVE STE F
MILL VALLEY CA
94941-2060
US

V. Phone/Fax

Practice location:
  • Phone: 415-389-8589
  • Fax:
Mailing address:
  • Phone: 415-389-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number223224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: