=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700819877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEGGY LYNN BAKKER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 W COUNTY LINE RD
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80129-1931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-798-0963
-----------------------------------------------------
Fax | 303-798-5069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6720 S ADAMS WAY
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-813-7721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 71475
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------