Provider Demographics
NPI:1194185397
Name:EINSELE, PEGGY M (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:M
Last Name:EINSELE
Suffix:
Gender:F
Credentials:FNP-C
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 211
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:CA
Mailing Address - Zip Code:96038-0211
Mailing Address - Country:US
Mailing Address - Phone:530-864-6949
Mailing Address - Fax:
Practice Address - Street 1:1501 S OREGON ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3425
Practice Address - Country:US
Practice Address - Phone:530-842-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily