Provider Demographics
NPI:1811871668
Name:PEAHOTA, THERESA (LPN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:PEAHOTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 HAYWOOD ESTATE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3681
Mailing Address - Country:US
Mailing Address - Phone:856-430-7966
Mailing Address - Fax:
Practice Address - Street 1:3161 E WARM SPRINGS RD STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3144
Practice Address - Country:US
Practice Address - Phone:702-463-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838169164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse