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General NPI Number Information
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NPI Number | 1225560162
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Entity Type | Individual
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Provider Name | PEGGY WREN APRN
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Gender | Female
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 704 W GROVE ST STE 3
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City | EL DORADO
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State | AR
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Zip | 71730
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Country | US
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Telephone | 870-875-5577
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Fax | 870-875-5507
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Provider Business Mailing Address
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Address Line | 704 W GROVE ST STE 3
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City | EL DORADO
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State | AR
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Zip | 71730-4469
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Country | US
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Telephone | 870-875-5577
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Fax | 870-875-5507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP132010
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A005118
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License Number State | AR
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