Healthcare Provider Details

I. General information

NPI: 1871592014
Provider Name (Legal Business Name): PEGGY KIBBEL ARNP,CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 116TH AVE NE SUITE 201
BELLEVUE WA
98004-3043
US

IV. Provider business mailing address

1800 116TH AVE NE SUITE 201
BELLEVUE WA
98004-3043
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3366
  • Fax: 425-943-3201
Mailing address:
  • Phone: 425-454-3366
  • Fax: 425-943-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30005594
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30005594
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: