Healthcare Provider Details

I. General information

NPI: 1528200813
Provider Name (Legal Business Name): JANINE DANETTE PEACOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32375 N GANTZEL RD
SAN TAN VALLEY AZ
85143-5110
US

IV. Provider business mailing address

PO BOX 2850
FLORENCE AZ
85132-3053
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-6100
  • Fax: 480-888-0679
Mailing address:
  • Phone: 480-474-6100
  • Fax: 480-888-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN154296
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: