Provider Demographics
NPI:1396700233
Name:PETERS, MARGO (RN)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HWY 36
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1453
Mailing Address - Country:US
Mailing Address - Phone:732-571-0025
Mailing Address - Fax:732-571-7868
Practice Address - Street 1:100 HWY 36
Practice Address - Street 2:SUITE 2C
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1453
Practice Address - Country:US
Practice Address - Phone:732-571-0025
Practice Address - Fax:732-571-7868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR03289000163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator