Provider Demographics
NPI:1619442019
Name:PEELGREN, DEANNA KAY (LSA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KAY
Last Name:PEELGREN
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 OAK RUN PKWY
Mailing Address - Street 2:STE. 505, RM #12
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5379
Mailing Address - Country:US
Mailing Address - Phone:210-598-2800
Mailing Address - Fax:
Practice Address - Street 1:2915 W BITTERS RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2007
Practice Address - Country:US
Practice Address - Phone:254-290-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00857246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
185830OtherNBSTSA