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General NPI Number Information
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NPI Number | 1083249759
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Entity Type | Organization
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Legal Business Name | NANCY J PECKENPAUGH NUTRITION PLLC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1216 TRUMANSBURG RD
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City | ITHACA
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State | NY
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Zip | 14850-1314
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Country | US
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Telephone | 607-272-1297
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Fax | 607-272-2366
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Provider Business Mailing Address
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Address Line | 1216 TRUMANSBURG RD
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City | ITHACA
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State | NY
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Zip | 14850-1314
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Country | US
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Telephone | 607-272-1297
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Fax | 607-272-2366
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Authorized Official
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Title or Position | DISREGARDED ENTITY
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Name | MS. NANCY JAMISON PECKENPAUGH
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Credential | RD, CDN, CDE, BC-ADM
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Telephone | 607-272-1297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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