Provider Demographics
NPI:1548010713
Name:PEGUEROS, SUSAN (RN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:PEGUEROS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1714
Mailing Address - Country:US
Mailing Address - Phone:706-263-4871
Mailing Address - Fax:
Practice Address - Street 1:235 PARKS MEMORIAL BUILDING
Practice Address - Street 2:SCHOOL OF NURSING CBX 063
Practice Address - City:MILLIDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-445-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN294388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse