Provider Demographics
NPI:1801151154
Name:SWANSEY, PEGGY (LPN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:SWANSEY
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 1:2200 N FLORIDA AVE TRLR 71
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5558
Mailing Address - Country:US
Mailing Address - Phone:575-415-3082
Mailing Address - Fax:
Practice Address - Street 1:2200 N FLORIDA AVE TRLR 71
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5558
Practice Address - Country:US
Practice Address - Phone:575-415-3082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310475-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse