Healthcare Provider Details

I. General information

NPI: 1790796704
Provider Name (Legal Business Name): PEGGY JAN BRIGGS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22007 MERIDIAN AVE E STE C
GRAHAM WA
98338
US

IV. Provider business mailing address

22007 MERIDIAN AVE E STE C
GRAHAM WA
98338-8412
US

V. Phone/Fax

Practice location:
  • Phone: 253-780-4930
  • Fax: 253-375-6842
Mailing address:
  • Phone: 253-780-4930
  • Fax: 253-375-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number521048
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60327305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: