Provider Demographics
NPI:1437333697
Name:PEHL, VERONICA C
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:C
Last Name:PEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:C
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:HSA 830 SCENIC DR. BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95320
Mailing Address - Country:US
Mailing Address - Phone:209-558-6815
Mailing Address - Fax:
Practice Address - Street 1:830 SCENIC DR BLDG 3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-558-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 504695163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management