Healthcare Provider Details

I. General information

NPI: 1043608441
Provider Name (Legal Business Name): AMBER LYNNE PECK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 SAVANNAH RD STE B
LEWES DE
19958-1514
US

IV. Provider business mailing address

8588 SILVER MIST RUN
MILTON DE
19968-3079
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-6698
  • Fax:
Mailing address:
  • Phone: 302-228-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL10032431
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000827
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000827
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: