Provider Demographics
NPI:1194824904
Name:PEABODY, PATRICIA JEANETTE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEANETTE
Last Name:PEABODY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 EMERALD PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5784
Mailing Address - Country:US
Mailing Address - Phone:252-752-2140
Mailing Address - Fax:252-752-8054
Practice Address - Street 1:2430 EMERALD PL
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5784
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:252-752-8054
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC020941367500000X
NC180099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00601415OtherRAILROAD MEDICARE
NC2608008BMedicare PIN
NCP00601415OtherRAILROAD MEDICARE