Provider Demographics
NPI:1962453290
Name:MARCHINI, PEGGY L (RDLD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:MARCHINI
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:L
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDLD
Mailing Address - Street 1:149 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-5216
Mailing Address - Country:US
Mailing Address - Phone:815-748-7725
Mailing Address - Fax:
Practice Address - Street 1:9 HEALTH SERVICES DR
Practice Address - Street 2:KISHWAUKEE COMMUNITY HOSPITAL DIABETES EDUCATION DEPT.
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9601
Practice Address - Country:US
Practice Address - Phone:815-748-8378
Practice Address - Fax:815-748-8356
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA305 00029133V00000X
IL164 000603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0160OtherJOHN DEERE HEALTH
039138OtherHEALTH ALLIANCE
IA0160OtherJOHN DEERE HEALTH
P63142Medicare UPIN
IAI6873Medicare PIN
039138OtherHEALTH ALLIANCE