Healthcare Provider Details

I. General information

NPI: 1811996176
Provider Name (Legal Business Name): CRAIG A PECK A.R.N.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N 16TH ST SUITE 16
SPRINGFIELD OR
97477-4175
US

IV. Provider business mailing address

960 N 16TH ST SUITE 16
SPRINGFIELD OR
97477-4175
US

V. Phone/Fax

Practice location:
  • Phone: 541-744-6172
  • Fax: 541-744-8608
Mailing address:
  • Phone: 541-744-6172
  • Fax: 541-744-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200350022NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: