Basic Information
| Provider Information | |||||||||
| NPI: | 1114946548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | ANP,MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 DELAFIELD ST STE 327 | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531883417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625241024 | ||||||||
| FaxNumber: | 2625248767 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 SUN VALLEY DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | DELAFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530182318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626464162 | ||||||||
| FaxNumber: | 2626462498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 87375-030 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 43928500 | 05 | WI | MEDICAID |