Provider Demographics
NPI:1467521922
Name:PEKEMA, BARBARA CORINNE (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:CORINNE
Last Name:PEKEMA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3432
Mailing Address - Country:US
Mailing Address - Phone:831-385-5471
Mailing Address - Fax:
Practice Address - Street 1:210 CANAL ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3432
Practice Address - Country:US
Practice Address - Phone:831-385-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277234363LF0000X
CARN277234171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator