Healthcare Provider Details

I. General information

NPI: 1760532295
Provider Name (Legal Business Name): CATHERINE L. PEACOCK RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 W CAMELBACK RD SUITE 102
PHOENIX AZ
85037-1355
US

IV. Provider business mailing address

3815 E BELL RD SUITE 2300
PHOENIX AZ
85032-2122
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-6999
  • Fax: 623-772-6444
Mailing address:
  • Phone: 602-931-4586
  • Fax: 602-931-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP180
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: