Provider Demographics
NPI:1992195754
Name:PESKIN, AMBER (APRN, AGCNS-BC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PESKIN
Suffix:
Gender:F
Credentials:APRN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 JACKIE CT
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-7800
Mailing Address - Country:US
Mailing Address - Phone:504-458-0817
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:CT-6
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-9078
Practice Address - Fax:504-842-0130
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133517163WN0800X
LAAP08277364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2398181Medicaid
LA431531YH3UMedicare PIN