Provider Demographics
NPI:1477976132
Name:PEGRAM, SUSAN P (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:PEGRAM
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 1:5763 S PRINCE ST
Mailing Address - Street 2:#553
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80160-0553
Mailing Address - Country:US
Mailing Address - Phone:720-257-4051
Mailing Address - Fax:866-332-2758
Practice Address - Street 1:5763 S PRINCE ST
Practice Address - Street 2:#553
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80160-0553
Practice Address - Country:US
Practice Address - Phone:720-257-4051
Practice Address - Fax:866-332-2758
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59773163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse