Provider Demographics
NPI:1083249759
Name:NANCY J PECKENPAUGH NUTRITION PLLC
Entity Type:Organization
Organization Name:NANCY J PECKENPAUGH NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISREGARDED ENTITY
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:PECKENPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN, CDE, BC-ADM
Authorized Official - Phone:607-272-1297
Mailing Address - Street 1:1216 TRUMANSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1314
Mailing Address - Country:US
Mailing Address - Phone:607-272-1297
Mailing Address - Fax:607-272-2366
Practice Address - Street 1:1216 TRUMANSBURG RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1314
Practice Address - Country:US
Practice Address - Phone:607-272-1297
Practice Address - Fax:607-272-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty