Provider Demographics
NPI:1134361058
Name:MOONEY, PEGGY LYNN (OWNER)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LYNN
Last Name:MOONEY
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 STATE HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:OH
Mailing Address - Zip Code:44849-9751
Mailing Address - Country:US
Mailing Address - Phone:740-482-2842
Mailing Address - Fax:740-482-2643
Practice Address - Street 1:8512 STATE HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:OH
Practice Address - Zip Code:44849-9751
Practice Address - Country:US
Practice Address - Phone:740-482-2842
Practice Address - Fax:740-482-2643
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor