Provider Demographics
NPI:1659617132
Name:KRUEGER, PEGGY ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANNE
Last Name:KRUEGER
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 1:3281 ASHUE RD
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-9762
Mailing Address - Country:US
Mailing Address - Phone:509-877-6955
Mailing Address - Fax:
Practice Address - Street 1:902 S 44TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3838
Practice Address - Country:US
Practice Address - Phone:509-573-2400
Practice Address - Fax:509-573-2424
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00048232163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse