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General NPI Number Information
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NPI Number | 1467635664
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Entity Type | Individual
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Provider Name | CAROL I PEAKE CNP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 5830 WOODROW DR
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City | SYLVANIA
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State | OH
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Zip | 43560-1245
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Country | US
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Telephone | 419-481-3493
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 WOODROW DR
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City | SYLVANIA
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State | OH
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Zip | 43560-1245
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Country | US
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Telephone | 419-481-3493
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN-177161 NP-09813
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704194858 NP-C
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License Number State | MI
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