Provider Demographics
NPI:1225560162
Name:WREN, PEGGY (APRN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:WREN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 W GROVE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4469
Mailing Address - Country:US
Mailing Address - Phone:870-875-5577
Mailing Address - Fax:870-875-5507
Practice Address - Street 1:704 W GROVE ST STE 3
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-875-5577
Practice Address - Fax:870-875-5507
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132010363LF0000X
ARA005118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily