Provider Demographics
NPI:1225886658
Name:MISITA, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MISITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-4095
Mailing Address - Country:US
Mailing Address - Phone:740-649-3998
Mailing Address - Fax:
Practice Address - Street 1:16 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4095
Practice Address - Country:US
Practice Address - Phone:740-649-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No347C00000XTransportation ServicesPrivate Vehicle