MEDICARE: PEACHES DUON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	841040	NV

General Provider Information

NPI Number	:	1326622788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEACHES DUON FNP-BC

Provider Business Mailing Address
First Line	:	1151 S NEVADA HIGHWAY 160
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4700
Country	:	US
Telephone Number	:	775-727-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 S NEVADA HIGHWAY 160
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4700
Country	:	US
Telephone Number	:	775-727-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	09/03/2021

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