Provider Demographics
NPI:1306301155
Name:KRAUSE-PITTENRIDGE, PEGGIE JEANNE (LPN)
Entity type:Individual
Prefix:
First Name:PEGGIE
Middle Name:JEANNE
Last Name:KRAUSE-PITTENRIDGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PEGGIE
Other - Middle Name:JEANNE
Other - Last Name:PITTENRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14214 E WILD JESSE WAY
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6606
Mailing Address - Country:US
Mailing Address - Phone:520-444-8144
Mailing Address - Fax:
Practice Address - Street 1:13801 E BENSON HWY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-9074
Practice Address - Country:US
Practice Address - Phone:520-879-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP052176164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse