Basic Information
| Provider Information | |||||||||
| NPI: | 1477140762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IWAMOTO PEGLER | ||||||||
| FirstName: | YUKIKO | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 BAYBERRY CIR | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176863695 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2201 45TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618426141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2020 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 9479767 | FL | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.