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General NPI Number Information
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NPI Number | 1255767059
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Entity Type | Individual
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Provider Name | HANNA PECK NP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 10/05/2013
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Provider Practice Location Address
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Address Line | 819 WORCESTER ST SUITE 3
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City | SPRINGFIELD
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State | MA
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Zip | 01151-1045
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Country | US
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Telephone | 413-543-6820
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Fax |
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Provider Business Mailing Address
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Address Line | 819 WORCESTER ST SUITE 3
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City | SPRINGFIELD
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State | MA
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Zip | 01151-1045
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Country | US
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Telephone | 413-543-6820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN2289608
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN2289608
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License Number State | MA
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