Healthcare Provider Details
I. General information
NPI: 1700321445
Provider Name (Legal Business Name): PEGGY PENN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5301 BRETT DR
PEARLAND TX
77584-1236
US
IV. Provider business mailing address
5301 BRETT DR
PEARLAND TX
77584-1236
US
V. Phone/Fax
- Phone: 832-621-9359
- Fax:
- Phone: 832-621-9359
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0600X |
| Taxonomy | Gerontology Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH1000X |
| Taxonomy | Hospice Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0600X |
| Taxonomy | Infection Control Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0705X |
| Taxonomy | Medical-Surgical Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 666663 |
| License Number State | TX |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171R00000X |
| Taxonomy | Interpreter |
| License Number | 666663 |
| License Number State | TX |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225800000X |
| Taxonomy | Recreation Therapist |
| License Number | 666663 |
| License Number State | TX |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 246RP1900X |
| Taxonomy | Phlebotomy Technician |
| License Number | 666663 |
| License Number State | TX |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3747P1801X |
| Taxonomy | Personal Care Attendant |
| License Number | 666663 |
| License Number State | TX |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 374U00000X |
| Taxonomy | Home Health Aide |
| License Number | 666663 |
| License Number State | TX |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 376K00000X |
| Taxonomy | Nurse's Aide |
| License Number | 666663 |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
