Provider Demographics
NPI:1669742284
Name:PEABBLES, YVONNE A (ANP)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:A
Last Name:PEABBLES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 SACO ST
Mailing Address - Street 2:28
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2023
Mailing Address - Country:US
Mailing Address - Phone:207-233-9885
Mailing Address - Fax:
Practice Address - Street 1:665 SACO ST
Practice Address - Street 2:28
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2023
Practice Address - Country:US
Practice Address - Phone:207-233-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141013363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health