Provider Demographics
NPI:1285396002
Name:PETERS, DESTANEY
Entity type:Individual
Prefix:
First Name:DESTANEY
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 W IRENE ST
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-3817
Mailing Address - Country:US
Mailing Address - Phone:775-910-9802
Mailing Address - Fax:
Practice Address - Street 1:2780 W IRENE ST
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-3817
Practice Address - Country:US
Practice Address - Phone:775-910-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care