Healthcare Provider Details

I. General information

NPI: 1760767867
Provider Name (Legal Business Name): MARCI PECK APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST 14-200
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

1630 SHERMAN AVE STE 200
EVANSTON IL
60201-3711
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7382
  • Fax:
Mailing address:
  • Phone: 847-534-3278
  • Fax: 224-271-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209009153
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: