Provider Demographics
NPI:1316124258
Name:MEHARRY, PEGGY LEE
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEE
Last Name:MEHARRY
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 1:847 SE WATSON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3926
Mailing Address - Country:US
Mailing Address - Phone:541-492-1246
Mailing Address - Fax:
Practice Address - Street 1:847 SE WATSON ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3926
Practice Address - Country:US
Practice Address - Phone:541-492-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090003224163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health