Provider Demographics
NPI:1386263846
Name:KAYE, PEGGY (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:KAYE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1532
Mailing Address - Country:US
Mailing Address - Phone:877-338-2785
Mailing Address - Fax:262-353-9868
Practice Address - Street 1:1932 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1532
Practice Address - Country:US
Practice Address - Phone:877-338-2785
Practice Address - Fax:262-353-9868
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112873163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100084280Medicaid