Basic Information
| Provider Information | |||||||||
| NPI: | 1194792580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 DELANEY RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107629083 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2450 DELANEY RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107629083 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0438 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6000101 | 05 | NC | MEDICAID | 7266127 | 01 | AETNA | OTHER | 900012686 | 01 | PRIORITY HEALTH | OTHER | 071991 | 01 | VALUE OPTIONS | OTHER | 70180 | 01 | MEDCOST | OTHER | 04360 | 01 | BLUE CROSS/BLUE SHIELD | OTHER | IPO39303 | 01 | MAGELLAN | OTHER | 61-07217 | 01 | UBH | OTHER |