Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY0517 | NV |
N | 103TC0700X | Clinical Psychologist | PY0517 | NV |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY0517 | NV |
NPI | 1003993049 |
---|---|
Provider Name | Dr. Peggy Renner |
First Address | Las Vegas, NV 89117-7528 |
Second Address | Las Vegas, NV 89117-7528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 17/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100507577 | (05) | NV |