Provider Demographics
NPI:1053784017
Name:HEUSER, PEGGY JANSON (APRN)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JANSON
Last Name:HEUSER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 METAL LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1094
Mailing Address - Country:US
Mailing Address - Phone:502-893-7833
Mailing Address - Fax:502-895-4418
Practice Address - Street 1:2040 METAL LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1094
Practice Address - Country:US
Practice Address - Phone:502-893-7833
Practice Address - Fax:502-895-4418
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009578364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health