Provider Demographics
NPI:1396737110
Name:MCGILL, PEGGY ELIZABETH DIXON (FNP-BC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ELIZABETH DIXON
Last Name:MCGILL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:ELIZABETH
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN
Mailing Address - Street 1:44274 GEORGE CUSHMAN CT STE 208
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5945
Mailing Address - Country:US
Mailing Address - Phone:951-501-4252
Mailing Address - Fax:951-900-3108
Practice Address - Street 1:44274 GEORGE CUSHMAN CT STE 208
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5945
Practice Address - Country:US
Practice Address - Phone:951-501-4252
Practice Address - Fax:951-900-3108
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357419363LF0000X
CAFNP10230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN357419OtherLICENSE
CAFNP 10230OtherLICENSE
CAFNP 10230OtherLICENSE