Individual
JEREESHA SHAUNTA PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 160 M.P. 394, KAYENTA, AZ 86033
(928) 697-4000
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4001
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
36163
WY
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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