Provider Demographics
NPI:1437408994
Name:MONTAGNA, PEGGY (LPN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MONTAGNA
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 1:111 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1620
Mailing Address - Country:US
Mailing Address - Phone:215-257-1341
Mailing Address - Fax:
Practice Address - Street 1:111 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-1620
Practice Address - Country:US
Practice Address - Phone:215-257-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN084287L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse