Healthcare Provider Details

I. General information

NPI: 1104934025
Provider Name (Legal Business Name): PEGGY C SCANSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALPENGLOW LANE
LIVINGSTON MT
59047
US

IV. Provider business mailing address

320 ALPENGLOW LANE
LIVINGSTON MT
59047
US

V. Phone/Fax

Practice location:
  • Phone: 406-823-6414
  • Fax: 406-823-6287
Mailing address:
  • Phone: 406-823-6414
  • Fax: 406-823-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN010950
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: