Provider Demographics
NPI:1285049148
Name:GEIS, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:GEIS
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 1:1029 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2764
Mailing Address - Country:US
Mailing Address - Phone:440-521-5248
Mailing Address - Fax:
Practice Address - Street 1:1029 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-2764
Practice Address - Country:US
Practice Address - Phone:440-521-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH433770397101Medicaid