Provider Demographics
NPI:1275917163
Name:PESIMER, PEGGY SUE
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:PESIMER
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 1:267 N VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3468
Mailing Address - Country:US
Mailing Address - Phone:740-485-9049
Mailing Address - Fax:
Practice Address - Street 1:267 N VERNON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3468
Practice Address - Country:US
Practice Address - Phone:740-485-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist