Provider Demographics
NPI:1780824151
Name:PECK, HOLLY CHRISTINE (MS,RD)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:CHRISTINE
Last Name:PECK
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 COLT LN
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-7883
Mailing Address - Country:US
Mailing Address - Phone:775-450-7976
Mailing Address - Fax:
Practice Address - Street 1:1908 COLT LN
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-7883
Practice Address - Country:US
Practice Address - Phone:775-450-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV800682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered