Provider Demographics
NPI:1942298294
Name:HIRTE, PEGGY ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:HIRTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:KEMPKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:706 AVENUE C
Mailing Address - Street 2:SUIT A
Mailing Address - City:WEST POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52656-9615
Mailing Address - Country:US
Mailing Address - Phone:319-470-7341
Mailing Address - Fax:
Practice Address - Street 1:706 AVENUE C
Practice Address - Street 2:SUIT A
Practice Address - City:WEST POINT
Practice Address - State:IA
Practice Address - Zip Code:52656-9615
Practice Address - Country:US
Practice Address - Phone:319-837-6115
Practice Address - Fax:319-837-6450
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF093374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433409Medicaid
IA90-0615535OtherTAX ID
IA0433409Medicaid
I3540Medicare ID - Type Unspecified