Christy M Henderson-peterson, NP | |
1721 Hammer Lane Suite A, Stockton, CA 95210-4116 | |
(209) 751-5200 | |
Not Available |
Full Name | Christy M Henderson-peterson |
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Gender | Female |
Speciality | Licensed Practical Nurse |
Location | 1721 Hammer Lane Suite A, Stockton, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1609957190 | NPI | - | NPPES |
NP11839 | Other | CA | LICENSE |
Taxonomy | Type | License (State) | Status |
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164W00000X | Licensed Practical Nurse | NP11839 (California) | Primary |
Entity Name | Community Medical Centers, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1588729180 PECOS PAC ID: 8426968520 Enrollment ID: O20101027000870 |
Mailing Address | Practice Location Address |
---|---|
Christy M Henderson-peterson, NP Po Box 779, Stockton, CA 95201 Ph: (209) 373-2829 | Christy M Henderson-peterson, NP 1721 Hammer Lane Suite A, Stockton, CA 95210-4116 Ph: (209) 751-5200 |
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