Provider Demographics
NPI:1285363036
Name:PEACE, ANGELA (CPT, CCMA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PEACE
Suffix:
Gender:F
Credentials:CPT, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WEEPING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6208
Mailing Address - Country:US
Mailing Address - Phone:919-423-9136
Mailing Address - Fax:
Practice Address - Street 1:3209 GUESS RD STE 106
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2692
Practice Address - Country:US
Practice Address - Phone:919-423-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCB8W8S4E6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy