Healthcare Provider Details

I. General information

NPI: 1396951190
Provider Name (Legal Business Name): PEGGY GILDERSLEEVE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEL POND DR ORCHARD COVE WELLNESS CENTER
CANTON MA
02021-2759
US

IV. Provider business mailing address

40 FERN ST
LEXINGTON MA
02421-6025
US

V. Phone/Fax

Practice location:
  • Phone: 781-821-3210
  • Fax: 781-821-3216
Mailing address:
  • Phone: 781-821-3210
  • Fax: 781-821-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number145848
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: