Healthcare Provider Details

I. General information

NPI: 1699030320
Provider Name (Legal Business Name): MS. PEGGY LORRAINE HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 RAINIER AVE S
SEATTLE WA
98118-2706
US

IV. Provider business mailing address

5802 RAINIER AVE. SOUTH
SEATTLE WASHINGTON
98118
UM

V. Phone/Fax

Practice location:
  • Phone: 206-723-1982
  • Fax:
Mailing address:
  • Phone: 206-723-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: