Provider Demographics
NPI:1265499255
Name:PERALTA, NANCY LEE (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:PERALTA
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:126 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4314
Mailing Address - Country:US
Mailing Address - Phone:404-377-0277
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:FAMILY PLANNING CLINIC
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-7927
Practice Address - Fax:404-616-2292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN053619 NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00694526AMedicaid