MEDICARE: PEGGY DAVIDSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	083037624RN	OR
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497156574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY DAVIDSON RN

Provider Business Mailing Address
First Line	:	876 SIGNAL WAY
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2237
Country	:	US
Telephone Number	:	541-297-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	876 SIGNAL WAY
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2237
Country	:	US
Telephone Number	:	541-297-2001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	06/15/2016

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