Healthcare Provider Details

I. General information

NPI: 1053784017
Provider Name (Legal Business Name): PEGGY JANSON HEUSER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 METAL LN
LOUISVILLE KY
40206-1094
US

IV. Provider business mailing address

2040 METAL LN
LOUISVILLE KY
40206-1094
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7833
  • Fax: 502-895-4418
Mailing address:
  • Phone: 502-893-7833
  • Fax: 502-895-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number3009578
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: