Healthcare Provider Details

I. General information

NPI: 1437574472
Provider Name (Legal Business Name): COLLEEN PECK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 4TH ST NE
WASHINGTON DC
20002-3431
US

IV. Provider business mailing address

1225 4TH ST NE
WASHINGTON DC
20002-3431
US

V. Phone/Fax

Practice location:
  • Phone: 202-347-8512
  • Fax:
Mailing address:
  • Phone: 202-347-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM200004151
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number024184601
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR167646
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: