Provider Demographics
NPI:1396278107
Name:HITCHCOCK, PEGGY (CNP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20265 EMERY ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH RANDALL
Mailing Address - State:OH
Mailing Address - Zip Code:44128-7617
Mailing Address - Country:US
Mailing Address - Phone:440-523-9966
Mailing Address - Fax:216-584-2895
Practice Address - Street 1:1415 WINKLER HILL RD NW
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-7617
Practice Address - Country:US
Practice Address - Phone:330-364-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH381316163W00000X
OHAPRN.CNP.021193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse