Provider Demographics
NPI:1063453215
Name:DULHANTY, PEGGY ANN
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:DULHANTY
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 1:2355 E BOCOCK RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-8751
Mailing Address - Country:US
Mailing Address - Phone:765-664-7429
Mailing Address - Fax:765-668-4993
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:765-677-5162
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000613A363LF0000X
IN28092871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196650AMedicaid
IN200196650AMedicaid
INS85746Medicare UPIN