MEDICARE: MRS. PEGGY O WILLMAN M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator	M.ED	NJ

General Provider Information

NPI Number	:	1013295864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PEGGY O WILLMAN M.ED

Provider Business Mailing Address
First Line	:	6 DARTMOUTH CT
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-9756
Country	:	US
Telephone Number	:	732-389-2833
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 DARTMOUTH CT
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-9756
Country	:	US
Telephone Number	:	732-389-2833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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