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NPI Code Detail

MEDICARE: MS. PEGGY L. JESSUP RN

MEDICARE: MS. PEGGY L. JESSUP RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse532700-1NY

General Provider Information

NPI Number : 1326342379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PEGGY L. JESSUP RN
Provider Business Mailing Address
First Line : 15 SCHOOL ST
Second Line :
City : SHERBURNE
State : NY
Zip : 13460-9505
Country : US
Telephone Number : 607-674-7389
Fax Number : 607-674-8440
Provider Business Practice Location Address
First Line : 15 SCHOOL ST
Second Line :
City : SHERBURNE
State : NY
Zip : 13460-9505
Country : US
Telephone Number : 607-674-7389
Fax Number : 607-674-8440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2011
Last Update Date : 01/05/2011

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