1649334905 NPI number — PEGGY JO WHITEPLUME OD

Table of content: PEGGY JO WHITEPLUME OD (NPI 1649334905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649334905 NPI number — PEGGY JO WHITEPLUME OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITEPLUME
Provider First Name:
PEGGY
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROYS
Provider Other First Name:
PEGGY
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649334905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PEGGY WHITEPLUME
Provider Second Line Business Mailing Address:
839 S. 6TH ST.
Provider Business Mailing Address City Name:
LANDER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-349-5196
Provider Business Mailing Address Fax Number:
307-332-3931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AMERICA'S BEST
Provider Second Line Business Practice Location Address:
1805 SE DELAWARE AVE SUITE 1000
Provider Business Practice Location Address City Name:
ANKENY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-333-5845
Provider Business Practice Location Address Fax Number:
515-333-5846
Provider Enumeration Date:
12/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002415A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 01905 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)