Individual
MRS. PEGGY VIOLET CHAIDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
164W00000X
Licensed Practical Nurse
Primary
201600347LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201600347LPN
LPN
OR
Enumeration date
10/27/2016
Last updated
10/28/2016
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