Healthcare Provider Details

I. General information

NPI: 1174234769
Provider Name (Legal Business Name): PEGGY SUE SCHARBERG CHAFFIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 FORT MISSOULA RD STE 121
MISSOULA MT
59804-7403
US

IV. Provider business mailing address

PO BOX 696
DARBY MT
59829-0696
US

V. Phone/Fax

Practice location:
  • Phone: 406-926-3500
  • Fax:
Mailing address:
  • Phone: 406-544-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNUR-APRN-LIC-206056
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: