Individual
PEGGY ICKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1445 35TH ST, LOS ALAMOS, NM 87544-2107
(505) 660-0317
Mailing address
1445 35TH ST, LOS ALAMOS, NM 87544-2107
(505) 660-0317
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-02030
NM
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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