Provider Demographics
NPI:1205062056
Name:UNDERWOOD, PEGGY ANN (LPN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1817
Mailing Address - Country:US
Mailing Address - Phone:570-385-8450
Mailing Address - Fax:570-385-8451
Practice Address - Street 1:223 ROUTE 61 S
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-9704
Practice Address - Country:US
Practice Address - Phone:570-385-8450
Practice Address - Fax:570-385-8451
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN055030L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse