Provider Demographics
NPI:1093701930
Name:DEITZ, PEGGY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:DEITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ASHELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4013
Mailing Address - Country:US
Mailing Address - Phone:828-258-1188
Mailing Address - Fax:
Practice Address - Street 1:147 ASHELAND AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4013
Practice Address - Country:US
Practice Address - Phone:828-258-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200960363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P27430Medicare UPIN
2599519Medicare ID - Type Unspecified