Provider Demographics
NPI:1871530998
Name:SCHAFFER, PEG (PA-C)
Entity type:Individual
Prefix:
First Name:PEG
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:MILLICAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4856 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5539
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:970-613-4475
Practice Address - Street 1:4856 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5539
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:970-613-4475
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.001645363A00000X
COPA1645363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant