Provider Demographics
NPI:1477002947
Name:HART, PEGGY
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:HART
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 1:1912 HAYES AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4736
Mailing Address - Country:US
Mailing Address - Phone:419-557-5594
Mailing Address - Fax:
Practice Address - Street 1:703 TYLER ST STE 352
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3391
Practice Address - Country:US
Practice Address - Phone:419-557-6161
Practice Address - Fax:419-557-5596
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.019389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner