Provider Demographics
NPI:1346224029
Name:KEULER, PEGGY L (NP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:KEULER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:SOBIESKI
Mailing Address - State:WI
Mailing Address - Zip Code:54171-9667
Mailing Address - Country:US
Mailing Address - Phone:920-822-8106
Mailing Address - Fax:
Practice Address - Street 1:1 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1949
Practice Address - Country:US
Practice Address - Phone:920-324-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35136Medicare UPIN