MEDICARE: DONNA BERNICE ALLEN-PEEBLES NP

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	0024167427	VA

General Provider Information

NPI Number	:	1386843548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA BERNICE ALLEN-PEEBLES NP

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 HARTFORD RD STE B
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6601
Country	:	US
Telephone Number	:	757-827-7754
Fax Number	:	757-827-0995

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	06/10/2014

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