Healthcare Provider Details

I. General information

NPI: 1790044667
Provider Name (Legal Business Name): PEGGY ANN SCHLOMER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY ANN SEIBEL

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S LEMAY AVE STE 240
FORT COLLINS CO
80524-3960
US

IV. Provider business mailing address

1107 S LEMAY AVE STE 240
FORT COLLINS CO
80524
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-7421
  • Fax: 970-495-7424
Mailing address:
  • Phone: 970-495-7421
  • Fax: 970-495-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119373
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1546
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: