Provider Demographics
NPI:1487792289
Name:JESSEN, PEGGY ANN (BSN RN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:JESSEN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PALMCROFT DRIVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7936
Mailing Address - Country:US
Mailing Address - Phone:928-502-8000
Mailing Address - Fax:928-314-0685
Practice Address - Street 1:901 PALMCROFT DRIVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7936
Practice Address - Country:US
Practice Address - Phone:928-502-8000
Practice Address - Fax:928-314-0685
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN086280163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool