Provider Demographics
NPI:1649288119
Name:KOHL, PEGGY A (CRNFA, CNS)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:A
Last Name:KOHL
Suffix:
Gender:F
Credentials:CRNFA, CNS
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNFA, CNS
Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:VASCULAR & GENERAL SURGERY ASSOC #201
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-596-6736
Mailing Address - Fax:562-596-5387
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:VASCULAR & GENERAL SURGERY ASSOC #201
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-596-6736
Practice Address - Fax:562-596-5387
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACN5461364S00000X
CACNS461364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S62274Medicare UPIN
CAS62274Medicare UPIN
CACN5461BMedicare ID - Type Unspecified
CACNS461BMedicare PIN
CACNS461AMedicare PIN