Basic Information
Provider Information | |||||||||
NPI: | 1811423122 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEACE | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | MARGARET | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | COLE | ||||||||
OtherFirstName: | STEPHANIE | ||||||||
OtherMiddleName: | MARGARET | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 385 CALLE DE ALEGRA STE A | ||||||||
Address2: |   | ||||||||
City: | LAS CRUCES | ||||||||
State: | NM | ||||||||
PostalCode: | 880053423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5755261105 | ||||||||
FaxNumber: | 5755244266 | ||||||||
Practice Location | |||||||||
Address1: | 385 CALLE DE ALEGRA BLDG C | ||||||||
Address2: |   | ||||||||
City: | LAS CRUCES | ||||||||
State: | NM | ||||||||
PostalCode: | 880053423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5755568200 | ||||||||
FaxNumber: | 5755217199 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2017 | ||||||||
LastUpdateDate: | 09/08/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/08/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 6729-851 | WI | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 69847-20 | WI | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207VX0000X | MD2021-0735 | NM | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.