Healthcare Provider Details

I. General information

NPI: 1952683518
Provider Name (Legal Business Name): KARSHIRA F. PESHLAKAI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 11/09/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNERS OF ROUTE 12&7
FT. DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax: 928-729-8639
Mailing address:
  • Phone: 505-722-1000
  • Fax: 505-722-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN168867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: