Provider Demographics
NPI:1316752520
Name:WHITEHURST, PEREGRINE ZOE ROBINS (LAC)
Entity type:Individual
Prefix:
First Name:PEREGRINE
Middle Name:ZOE ROBINS
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19320 WYMER LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8874
Mailing Address - Country:US
Mailing Address - Phone:415-652-3763
Mailing Address - Fax:
Practice Address - Street 1:421 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2407
Practice Address - Country:US
Practice Address - Phone:530-268-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18978171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist