| Doctor Name: | MRS. MARYKAY PETGES |
| NPI Number: | 1295938645 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | |
| Business Practice Address: | 101 Birch Dr Sw Poplar Grove, IL - 610658962 |
| Business Phone Number: | 8157651418 |
| Business Fax Number: | 8157650971 |
| Mailing Address: | 101 Birch Dr Sw, POPLAR GROVE |
| State: | IL |
| Postal Code: | 610658962 |
| Phone Number: | 8157651418 |
| Fax Number: | 8157650971 |
| NPI Enumeration Date: | 06/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |