Provider Demographics
NPI:1093986036
Name:CONLEY, PEGGY L (LPN)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:L
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:JILLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 MINGO DRIVE PL VALLEY
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-774-1513
Mailing Address - Fax:
Practice Address - Street 1:70 MINGO DRIVE PL VALLEY
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-774-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 054193164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2623174Medicaid