Healthcare Provider Details

I. General information

NPI: 1497785802
Provider Name (Legal Business Name): PEGGY GLAUBKE DALY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E COUNTY LINE RD STE 2
INDIANAPOLIS IN
46227-1004
US

IV. Provider business mailing address

1250 E COUNTY LINE RD STE 2
INDIANAPOLIS IN
46227-1004
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-3677
  • Fax: 317-885-3678
Mailing address:
  • Phone: 317-885-3677
  • Fax: 317-885-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71000465
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: