Provider Demographics
NPI:1265412159
Name:PECKHAM-DEVINE, BARBARA S (CNM)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:PECKHAM-DEVINE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD STE 209
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3724
Mailing Address - Country:US
Mailing Address - Phone:412-267-6600
Mailing Address - Fax:412-267-6281
Practice Address - Street 1:500 W THOMAS RD STE 720&730
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-406-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE120003367A00000X
PA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103470380Medicaid
NE276565Medicare ID - Type Unspecified