Provider Demographics
NPI:1841210739
Name:BLACK, PEGGIE J ARRECHE (APRN)
Entity Type:Individual
Prefix:
First Name:PEGGIE
Middle Name:J ARRECHE
Last Name:BLACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:PEGGIE
Other - Middle Name:J
Other - Last Name:ARRECHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:STE 400
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1262
Practice Address - Country:US
Practice Address - Phone:775-982-2400
Practice Address - Fax:775-982-2888
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN00536363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1841210739Medicaid
11832580OtherCAQH
NVV109270Medicare PIN
NV1841210739Medicaid