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NPI Code Detail

MEDICARE: PEGGIE J HURTEAU N.P.

MEDICARE: PEGGIE J HURTEAU N.P.
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
1363LF0000XFamily Nurse PractitionerIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00322265OTHERILMETRAHEALTH RR

General Provider Information

NPI Number : 1760431373
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGIE J HURTEAU N.P.
Provider Business Mailing Address
First Line : 21333 HAGGERTY RD
Second Line : SUITE 150
City : NOVI
State : MI
Zip : 48375-5510
Country : US
Telephone Number : 248-662-0250
Fax Number : 248-662-9844
Provider Business Practice Location Address
First Line : 393 E EDWARDSVILLE RD
Second Line :
City : WOOD RIVER
State : IL
Zip : 62095-1646
Country : US
Telephone Number : 618-259-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 12/21/2025

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