Provider Demographics
NPI:1396009924
Name:TENNEY, PEGGY ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:TENNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6274 YOUNGSTOWN KINGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FARMDALE
Mailing Address - State:OH
Mailing Address - Zip Code:44417-9716
Mailing Address - Country:US
Mailing Address - Phone:330-240-6536
Mailing Address - Fax:
Practice Address - Street 1:6274 YOUNGSTOWN KINGSVILLE RD
Practice Address - Street 2:
Practice Address - City:FARMDALE
Practice Address - State:OH
Practice Address - Zip Code:44417-9716
Practice Address - Country:US
Practice Address - Phone:330-240-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-092677164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse