Provider Demographics
NPI:1104934025
Name:SCANSON, PEGGY C (APRN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:C
Last Name:SCANSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ALPENGLOW LANE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047
Mailing Address - Country:US
Mailing Address - Phone:406-823-6414
Mailing Address - Fax:406-823-6287
Practice Address - Street 1:320 ALPENGLOW LANE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-823-6414
Practice Address - Fax:406-823-6287
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN010950363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT500003914OtherMEDICARE RR
MT000037361OtherBLUECROSSBLUESHIELD
MT0431630Medicaid
MT000037361OtherBLUECROSSBLUESHIELD
MT000081046Medicare PIN