Individual
PEGGY GRANDY GALLUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
635 E BASELINE RD, PHOENIX, AZ 85042-6551
(602) 243-7277
(602) 243-1235
Mailing address
2702 NORTH 3RD STREET, SUITE 4020, PHOENIX, AZ 85004-4608
(602) 323-3345
(602) 323-3499
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN084459
AZ
363LW0102X
Women's Health Nurse Practitioner
Primary
A6793
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000037
—
AZ
Enumeration date
02/09/2006
Last updated
07/02/2015
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