Healthcare Provider Details

I. General information

NPI: 1386263846
Provider Name (Legal Business Name): PEGGY KAYE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 WOODLAWN AVE
WEST BEND WI
53090-1532
US

IV. Provider business mailing address

1932 WOODLAWN AVE
WEST BEND WI
53090-1532
US

V. Phone/Fax

Practice location:
  • Phone: 877-338-2785
  • Fax: 262-353-9868
Mailing address:
  • Phone: 877-338-2785
  • Fax: 262-353-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number112873
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: