Provider Demographics
NPI:1811014640
Name:TYRRELL, PEGGY R (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:R
Last Name:TYRRELL
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 1:2505 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-2818
Mailing Address - Country:US
Mailing Address - Phone:580-765-8863
Mailing Address - Fax:
Practice Address - Street 1:2505 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-2818
Practice Address - Country:US
Practice Address - Phone:580-765-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0043134163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse