Provider Demographics
NPI:1467010538
Name:JARAMILLO, PEGGY (LVN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-3041
Mailing Address - Country:US
Mailing Address - Phone:817-936-5654
Mailing Address - Fax:
Practice Address - Street 1:411 S WICKER AVE
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-3041
Practice Address - Country:US
Practice Address - Phone:817-936-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186872164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse