Individual
PEGGY ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP
Contact information
Practice address
809 STATE ST, SUITE 401A, LA PORTE, IN 46350-3390
(219) 326-6808
Mailing address
2810 ELBRIDGE WAY, LONG BEACH, IN 46360-1612
(219) 861-2765
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001276A
IN
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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