Provider Demographics
NPI:1275679490
Name:MACKEY, PEGGY ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 THE CAPES BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1464
Mailing Address - Country:US
Mailing Address - Phone:440-357-8210
Mailing Address - Fax:440-357-8210
Practice Address - Street 1:1017 THE CAPES BLVD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1464
Practice Address - Country:US
Practice Address - Phone:440-357-8210
Practice Address - Fax:440-357-8210
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN041524164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172509Medicare UPIN