Provider Demographics
NPI:1366867681
Name:SINES, PEGGE
Entity Type:Individual
Prefix:
First Name:PEGGE
Middle Name:
Last Name:SINES
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 1:233 E MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:OH
Mailing Address - Zip Code:43517-9302
Mailing Address - Country:US
Mailing Address - Phone:419-298-3377
Mailing Address - Fax:
Practice Address - Street 1:233 E MORRISON ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:OH
Practice Address - Zip Code:43517-9302
Practice Address - Country:US
Practice Address - Phone:419-298-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04-2260261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04-2260OtherADULT CARE FACILITIY