Provider Demographics
NPI:1427412519
Name:FORDE, PEGGY-ANNE MICHELLE
Entity Type:Individual
Prefix:MS
First Name:PEGGY-ANNE
Middle Name:MICHELLE
Last Name:FORDE
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 1:20 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4980
Mailing Address - Country:US
Mailing Address - Phone:516-326-2020
Mailing Address - Fax:
Practice Address - Street 1:20 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4980
Practice Address - Country:US
Practice Address - Phone:516-326-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse