Provider Demographics
NPI:1720449275
Name:PELT, DONALD JOSEPH (EMT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:PELT
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CAPITAL HILL DR.
Mailing Address - Street 2:P.O. BOX 256
Mailing Address - City:NIXON
Mailing Address - State:NV
Mailing Address - Zip Code:89424-0256
Mailing Address - Country:US
Mailing Address - Phone:775-560-4417
Mailing Address - Fax:775-574-1008
Practice Address - Street 1:104 STATE ROUTE 447
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424-0256
Practice Address - Country:US
Practice Address - Phone:775-560-4417
Practice Address - Fax:775-574-1008
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV71894146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881007037OtherEMS NPI