Provider Demographics
NPI:1164867131
Name:AYALA, PEGGY (RN, PHN, CDCES)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:RN, PHN, CDCES
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:RUUD, RUUD-AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:971-217-9008
Mailing Address - Fax:971-269-0355
Practice Address - Street 1:1438 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1140
Practice Address - Country:US
Practice Address - Phone:503-548-0346
Practice Address - Fax:503-232-5959
Is Sole Proprietor?:No
Enumeration Date:2013-05-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201404679RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse