Individual
MS. PEGGY J RIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
17175 SW TV HWY STE B2, ALOHA, OR 97006-4584
(503) 941-3017
Mailing address
17175 SW TV HWY STE B2, ALOHA, OR 97006-4584
(503) 941-3017
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
200250074NP ANP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
AP30006298
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009
WORKMAN'S COMPENSATION CERTIFIED PROVIDER
OR
01
—
825622005
BLUE CROSS/BLUE SHIELD/TRIWEST
—
Enumeration date
09/20/2005
Last updated
12/09/2011
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