Provider Demographics
NPI:1952047029
Name:MACASIEB, PEGGY NODERAMA (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:NODERAMA
Last Name:MACASIEB
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5981 JEFFERSON ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3457
Mailing Address - Country:US
Mailing Address - Phone:505-370-9600
Mailing Address - Fax:
Practice Address - Street 1:40 FIRST PLAZA CTR NW STE 62
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-6543
Practice Address - Country:US
Practice Address - Phone:505-242-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF0522055363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner