Provider Demographics
NPI:1336367275
Name:SIX, PEGGY ANN (RN, BA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:SIX
Suffix:
Gender:F
Credentials:RN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 SILVER TWINE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1341
Mailing Address - Country:US
Mailing Address - Phone:410-913-8801
Mailing Address - Fax:
Practice Address - Street 1:415 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-3000
Practice Address - Country:US
Practice Address - Phone:410-691-4344
Practice Address - Fax:410-691-4359
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR108133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse