Healthcare Provider Details

I. General information

NPI: 1689587719
Provider Name (Legal Business Name): MICHAEL FREDERICK PEABODY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 LAKESIDE DR STE 200
RENO NV
89509-5371
US

IV. Provider business mailing address

3708 LAKESIDE DR STE 200
RENO NV
89509-5371
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-8090
  • Fax: 775-826-8090
Mailing address:
  • Phone: 775-826-8090
  • Fax: 775-826-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: