Provider Demographics
NPI:1508163338
Name:PHILPOT, PEGGY RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:RENEE
Last Name:PHILPOT
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 1:7551 MIDDLETOWN GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1044
Mailing Address - Country:US
Mailing Address - Phone:937-689-3286
Mailing Address - Fax:
Practice Address - Street 1:7551 MIDDLETOWN GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1044
Practice Address - Country:US
Practice Address - Phone:937-689-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.364480163W00000X
OHPN.132007-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse