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General NPI Number Information
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NPI Number | 1134295249
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Entity Type | Individual
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Provider Name | PEGGY LOUISE VANPATTEN M.S.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3900 LAKEVILLE HWY
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City | PETALUMA
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State | CA
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Zip | 94954-5698
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Country | US
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Telephone | 707-765-3516
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Fax | 707-765-3746
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Provider Business Mailing Address
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Address Line | 18 GILBERT WAY
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City | COTATI
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State | CA
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Zip | 94931-5157
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Country | US
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Telephone | 707-795-2604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU802
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License Number State | CA
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