MEDICARE: MRS. PEGGY JEAN HALSEY CDM, CPM

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	176B00000X	Midwife	44	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	44	OTHER	AK	STATE LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891918686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PEGGY JEAN HALSEY CDM, CPM

Provider Business Mailing Address
First Line	:	PO BOX 874486
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-4486
Country	:	US
Telephone Number	:	907-841-2565
Fax Number	:	888-862-1422

Provider Business Practice Location Address
First Line	:	2405 S. KNIK GOOSE BAY ROAD
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654
Country	:	US
Telephone Number	:	907-841-2565
Fax Number	:	888-862-1422

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/12/2018

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Directions to “ MRS. PEGGY JEAN HALSEY CDM, CPM” Practice Location

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