Provider Demographics
NPI:1760742829
Name:PECKENPAUG, SIRKKA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SIRKKA
Middle Name:
Last Name:PECKENPAUG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7789 ARUNDEL MILLS BLVD
Mailing Address - Street 2:APT # 203
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1996
Mailing Address - Country:US
Mailing Address - Phone:240-460-8472
Mailing Address - Fax:
Practice Address - Street 1:7789 ARUNDEL MILLS BLVD
Practice Address - Street 2:APT # 203
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1996
Practice Address - Country:US
Practice Address - Phone:240-460-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1003311164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse