Provider Demographics
NPI:1265511083
Name:ELS, PEGGY (LVN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:ELS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N JOEKEL AVE
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-2171
Mailing Address - Country:US
Mailing Address - Phone:979-542-1260
Mailing Address - Fax:979-773-9420
Practice Address - Street 1:713 N JOEKEL AVE
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-2171
Practice Address - Country:US
Practice Address - Phone:979-542-1260
Practice Address - Fax:979-773-9420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130109164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse