Provider Demographics
NPI:1316416423
Name:MANN, PEGGY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LYNN
Last Name:MANN
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 1:5624 HUNTERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2873
Mailing Address - Country:US
Mailing Address - Phone:937-203-6366
Mailing Address - Fax:
Practice Address - Street 1:33 W 1ST ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1298
Practice Address - Country:US
Practice Address - Phone:937-293-1945
Practice Address - Fax:937-293-8150
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse