Provider Demographics
NPI:1396234555
Name:HEIN, PEGGY JEAN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JEAN
Last Name:HEIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:JEAN
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W5828 CLEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-9472
Mailing Address - Country:US
Mailing Address - Phone:715-966-0196
Mailing Address - Fax:
Practice Address - Street 1:4477 FETKE LAKE RD
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-9796
Practice Address - Country:US
Practice Address - Phone:715-369-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3090394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse