Provider Demographics
NPI:1730142126
Name:TAUBENHEIM, PEGGY L (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:TAUBENHEIM
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 1:26211 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:WIND LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1461
Mailing Address - Country:US
Mailing Address - Phone:262-895-2086
Mailing Address - Fax:262-895-2086
Practice Address - Street 1:26211 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:WIND LAKE
Practice Address - State:WI
Practice Address - Zip Code:53185-1461
Practice Address - Country:US
Practice Address - Phone:262-895-2086
Practice Address - Fax:262-895-2086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39988900Medicaid