Provider Demographics
NPI:1356535660
Name:MICHEL, PEGGY A (CRNA)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:MICHEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4260
Practice Address - Fax:206-598-8812
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004491367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA23990UOtherREGENCE BLUESHIELD
WA9606997Medicaid
WA0224600OtherLABOR & INDUSTRY