Provider Demographics
NPI:1659407088
Name:WHITE, PEGGI J (NP)
Entity Type:Individual
Prefix:
First Name:PEGGI
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:204 WEST UNIVERSITY
Practice Address - Street 2:CARLE ADDICTION RECOVERY CENTER
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-383-6039
Practice Address - Fax:217-328-3581
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209000329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS88600Medicare UPIN
ILIL3270375Medicare PIN
S88600Medicare UPIN