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Individual

JOAN MARIE PEACOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
6100 PAN AMERICAN FREEWAY NE STE 450, ALBUQUERQUE, NM 87109-3460
(505) 823-8787
(505) 823-8788
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP01354
NM
364SW0102X
Women's Health Clinical Nurse Specialist
R56766
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000271730
NM
05
66175526
CO
Enumeration date
09/22/2005
Last updated
03/17/2018
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