Provider Demographics
NPI:1720792443
Name:HENDERSON, PEGGY JEAN
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JEAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4968
Mailing Address - Country:US
Mailing Address - Phone:740-973-9904
Mailing Address - Fax:
Practice Address - Street 1:3094 MARTINSBURG RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-8763
Practice Address - Country:US
Practice Address - Phone:740-973-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide