Provider Demographics
NPI:1417398322
Name:PEAGLER, BRIDGET RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:RENEE
Last Name:PEAGLER
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 1:21400 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3818
Mailing Address - Country:US
Mailing Address - Phone:313-333-3463
Mailing Address - Fax:
Practice Address - Street 1:21400 KIPLING ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3818
Practice Address - Country:US
Practice Address - Phone:313-333-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254948163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse