Provider Demographics
NPI:1013075316
Name:PLACE, PEGGY BALLARD (FNP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:BALLARD
Last Name:PLACE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16131 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4314
Mailing Address - Country:US
Mailing Address - Phone:530-273-1320
Mailing Address - Fax:
Practice Address - Street 1:10052 ALTA SIERRA DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-6886
Practice Address - Country:US
Practice Address - Phone:530-477-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily