PEGGY ICKES (NPI# 1255681474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255681474 |
| Entity Type | Individual |
| Full Name | PEGGY ICKES |
| Credential | FNP-BC |
| Practice Address |
1445 35th St Los Alamos NM 87544-2107 |
| Practice Telephone | 5056600317 |
| Mailing Telephone | 5056600317 |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
CNP-02030 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1445 35TH ST |
| City | LOS ALAMOS |
| State | NM |
| Zip Code | 87544-2107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679945935 | Zia Home Health | Home Health | 1475 Central Ave., Suite 125, Los Alamos, NM 87544 | 2015-10-27 |
| 1295131167 | Sara Pocernik | Dietitian, Registered | 1450 Iris Street, Los Alamos, NM 87544 | 2014-11-05 |
| 1760824890 | Lisa Renee Marr Lyon | Psychologist | 3917 West Road, Suite 128, Children's Clinic, P.a., Los Alamos, NM 87544 | 2013-07-17 |
| 1558629725 | Rachel Meyer | Dentist | 112 Central Park Square, Los Alamos, NM 87544 | 2012-04-25 |
| 1902183908 | Susana T. Chavarria | Occupational Therapist | 5 Quemazon Pl., Los Alamos, NM 87544 | 2011-11-04 |
| 1881998664 | Dr. Tom Child and Adolescent Medicine | Pediatrics | Los Alamos Medical Center, 3917 West Rd, Suite M250, Los Alamos, NM 87544 | 2011-01-07 |
| 1952565905 | Dawn Judy Barr | Social Worker | 3 Agila Ct, Los Alamos, NM 87544 | 2008-07-17 |
| 1649452129 | Ellen Vandergust Ballard | Dentist | 111 Longview, Suite B-3, White Rock, NM 87544 | 2007-11-27 |
| 1629290283 | Wildwind Dental | Dentist | 111 Longview Drive, Suite B3, Los Alamos, NM 87544 | 2007-05-03 |
| 1255407342 | Sarah Sue Teasdale | Counselor | 1362 C Trinity Dr, Los Alamos, NM 87544 | 2006-11-28 |
| Find all providers in zip 87544 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083267363 | Angela Marie Minium | Nurse Practitioner | 118 Central Park Sq, Los Alamos, NM 87544-4021 | 2019-07-16 |
| 1124576327 | Clay Schneider | Nurse Practitioner | 3917 West Rd, Los Alamos, NM 87544-2275 | 2016-09-15 |
| 1659798775 | Adriana Gonzales | Nurse Practitioner | 3917 West Road, Ste. A, Los Alamos, NM 87544 | 2014-03-26 |
| 1740337146 | Mara Trainer | Nurse Practitioner | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2007-01-05 |
| 1740378546 | Karen Anne Schneider | Nurse Practitioner | 3917 West Road Suite A, Medical Associates of Northern New Mexico, Los Alamos, NM 87544 | 2006-10-10 |
| 1609969179 | Susan Skelton | Nurse Practitioner | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447851845 | Jessica Montoya | Nurse Practitioner | 119 California Pine Rd Ne, Rio Rancho, NM 87124-2505 | 2020-11-03 |
| 1497354328 | Tracy Bui | Nurse Practitioner | 9200 Timber Ridge Rd Nw, Albuquerque, NM 87120-6278 | 2020-10-21 |
| 1477152619 | Aileen Liong | Nurse Practitioner | 3820 Dynamite Rd Ne, Rio Rancho, NM 87144-4160 | 2020-10-20 |
| 1578162822 | Holly Killough | Nurse Practitioner | 2332 Cottage San Rd, Silver City, NM 88061-8966 | 2020-10-19 |
| 1558969253 | Beverly Carter | Nurse Practitioner | 5021 Nelson Pl Nw, Albuquerque, NM 87114-4320 | 2020-10-14 |
| 1932706223 | Rozita Dayani | Nurse Practitioner | 6821 Promenade Ave Ne, Albuquerque, NM 87109-2824 | 2020-10-08 |
| 1730795626 | Jia Wu | Nurse Practitioner | 7124 Marseille Pl Ne, Albuquerque, NM 87122-3328 | 2020-09-17 |
| 1912513870 | Ariel A Nunez | Nurse Practitioner | 500 Walter Street Ne, Suite 216, Lovelace Medical Towers - Clinical Informatics, Albuquerque, NM 87102-2543 | 2020-09-16 |
| 1114531100 | Anneliese K. Glasgow | Nurse Practitioner | 2515 Tiffany Dr, Las Cruces, NM 88011-0880 | 2020-09-07 |
| 1326652173 | Matthew S Fogel | Nurse Practitioner | 3129 Casa Bonita Dr Ne, Albuquerque, NM 87111-5607 | 2020-08-31 |
| Find all providers with the same taxonomy | ||||
| City | LOS ALAMOS |
| Zip Code | 87544 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.