1962453290 NPI number — PEGGY L MARCHINI RDLD

Table of content: PEGGY L MARCHINI RDLD (NPI 1962453290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962453290 NPI number — PEGGY L MARCHINI RDLD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCHINI
Provider First Name:
PEGGY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDLD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARLSON
Provider Other First Name:
PEGGY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDLD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962453290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 BERKSHIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEKALB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60115-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-748-7725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 HEALTH SERVICES DR
Provider Second Line Business Practice Location Address:
KISHWAUKEE COMMUNITY HOSPITAL DIABETES EDUCATION DEPT.
Provider Business Practice Location Address City Name:
DEKALB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60115-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-748-8378
Provider Business Practice Location Address Fax Number:
815-748-8356
Provider Enumeration Date:
05/12/2006

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: 133V00000X , with the licence number:  305 00029 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 164 000603 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IA0160 . This is a "JOHN DEERE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 039138 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".