Provider Demographics
NPI:1134552649
Name:PESCHEL, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:PESCHEL
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 1:100 BLASSINGAME RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3304
Mailing Address - Country:US
Mailing Address - Phone:864-355-3100
Mailing Address - Fax:
Practice Address - Street 1:100 BLASSINGAME RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3304
Practice Address - Country:US
Practice Address - Phone:864-355-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR14590164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse