Individual
AUDREY ALEXIS-PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10724 155TH ST, JAMAICA, NY 11433-1924
(347) 510-9972
Mailing address
10724 155TH ST, JAMAICA, NY 11433-1924
(347) 510-9972
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303041
NY
Other
Enumeration date
12/16/2010
Last updated
10/31/2011
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