Healthcare Provider Details

I. General information

NPI: 1477439230
Provider Name (Legal Business Name): ANDREA PECKINPAUGH LM, CPM, BSM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16050 WAYNE ST
UNION MI
49130-9637
US

IV. Provider business mailing address

55279 BUCKHORN RD
THREE RIVERS MI
49093-9651
US

V. Phone/Fax

Practice location:
  • Phone: 574-248-2485
  • Fax:
Mailing address:
  • Phone: 269-929-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: