Provider Demographics
NPI:1013247295
Name:O'NEAL, PEGGY S (CERTIFIED NURSE - MI)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:S
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:CERTIFIED NURSE - MI
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:S
Other - Last Name:GANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-333-3600
Mailing Address - Fax:808-961-5167
Practice Address - Street 1:15-2866 PAHOA VILLAGE RD BLDG C
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7720
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI74555163W00000X
TN15831363L00000X
TN155640363L00000X
HI1692363L00000X
GARN206655367A00000X
HI13163367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner