Healthcare Provider Details

I. General information

NPI: 1659229193
Provider Name (Legal Business Name): ANDREA NICOLE PEAKE MSN, RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 TRADE CENTRE WAY STE 140
PORTAGE MI
49002-0409
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0784
  • Fax:
Mailing address:
  • Phone: 517-492-0784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704346521
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704346521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: