Provider Demographics
NPI:1508521980
Name:PETERKIN, DENISE MICHELLE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:PETERKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SPRING MOUNTAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8629
Mailing Address - Country:US
Mailing Address - Phone:725-206-5714
Mailing Address - Fax:
Practice Address - Street 1:3305 SPRING MOUNTAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8629
Practice Address - Country:US
Practice Address - Phone:725-206-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant