Individual
PEGGY MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
Mailing address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004172
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427337209
—
IL
Enumeration date
02/10/2006
Last updated
02/10/2010
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