Provider Demographics
NPI:1083312581
Name:PEUTZ, JOEY (MS)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:PEUTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-0010
Mailing Address - Country:US
Mailing Address - Phone:208-642-6022
Mailing Address - Fax:208-642-6034
Practice Address - Street 1:16 S 9TH ST
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2855
Practice Address - Country:US
Practice Address - Phone:208-642-6022
Practice Address - Fax:208-642-6034
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator