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General NPI Number Information
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NPI Number | 1619901535
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Entity Type | Individual
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Provider Name | EARLENE JANE PECKHAM APRN,CPNP,MSN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 191 FOUNTAIN ST
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City | NEW HAVEN
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State | CT
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Zip | 06515-1901
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Country | US
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Telephone | 203-946-6606
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Fax | 203-946-6637
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Provider Business Mailing Address
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Address Line | 658 CHESTNUT RIDGE RD
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City | ORANGE
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State | CT
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Zip | 06477-2029
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Country | US
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Telephone | 203-387-9967
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 000425
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License Number State | CT
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