Provider Demographics
NPI:1194794347
Name:TROLLER, PEGGY J (RN)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:J
Last Name:TROLLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9278 130TH ST
Mailing Address - Street 2:
Mailing Address - City:DOWNING
Mailing Address - State:WI
Mailing Address - Zip Code:54734-9481
Mailing Address - Country:US
Mailing Address - Phone:715-643-2064
Mailing Address - Fax:715-643-2064
Practice Address - Street 1:N9278 130TH ST
Practice Address - Street 2:
Practice Address - City:DOWNING
Practice Address - State:WI
Practice Address - Zip Code:54734-9481
Practice Address - Country:US
Practice Address - Phone:715-643-2064
Practice Address - Fax:715-643-2064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-133445-8163W00000X
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38249900Medicaid