| NPI | 1992254627 |
|---|---|
| Former Name | PEGGY JOAN PETRICEK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NE 16393) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |