Healthcare Provider Details

I. General information

NPI: 1447332366
Provider Name (Legal Business Name): DARLENE RENEE PECK NP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-4213
  • Fax: 707-571-4299
Mailing address:
  • Phone: 707-571-4213
  • Fax: 707-571-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number258589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: