Healthcare Provider Details

I. General information

NPI: 1356961809
Provider Name (Legal Business Name): CRAIG PEEL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W GARDNER DR
MARION IN
46952-1819
US

IV. Provider business mailing address

4189 N 300 E
MARION IN
46952-6816
US

V. Phone/Fax

Practice location:
  • Phone: 765-651-4278
  • Fax:
Mailing address:
  • Phone: 765-661-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28162730A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28162730A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: