Provider Demographics
NPI:1437152022
Name:WILKERSON, PEGGYE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:PEGGYE
Middle Name:ANN
Last Name:WILKERSON
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 1:7500 SECURITY BLVD
Mailing Address - Street 2:MAIL STOP S2-12-25
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:410-786-4857
Mailing Address - Fax:410-786-6371
Practice Address - Street 1:7500 SECURITY BLVD
Practice Address - Street 2:MAIL STOP S2-12-25
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244
Practice Address - Country:US
Practice Address - Phone:410-786-4857
Practice Address - Fax:410-786-6371
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR12902163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator