=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124297924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEGGY ANN LOVELACE RD,LDN,CDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2008
-----------------------------------------------------
Last Update Date | 11/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 V TWIN DR STE 205
-----------------------------------------------------
City | GETTYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17325-7875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-339-2790
-----------------------------------------------------
Fax | 717-798-3162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3421 CONCORD RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-9001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-339-2790
-----------------------------------------------------
Fax | 717-798-3162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DN000831
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------