Healthcare Provider Details

I. General information

NPI: 1265511083
Provider Name (Legal Business Name): PEGGY ELS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 N JOEKEL AVE
GIDDINGS TX
78942-2171
US

IV. Provider business mailing address

713 N JOEKEL AVE
GIDDINGS TX
78942-2171
US

V. Phone/Fax

Practice location:
  • Phone: 979-542-1260
  • Fax: 979-773-9420
Mailing address:
  • Phone: 979-542-1260
  • Fax: 979-773-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number130109
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: