Provider Demographics
NPI:1255578720
Name:PECKOVITCH, RENEE LYNN (RN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:PECKOVITCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DEDRICK RD
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-5409
Mailing Address - Country:US
Mailing Address - Phone:518-943-3410
Mailing Address - Fax:
Practice Address - Street 1:9 DEDRICK RD
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5409
Practice Address - Country:US
Practice Address - Phone:518-943-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473992163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health