MEDICARE: BRENDA PECK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	47031053541	MI

General Provider Information

NPI Number	:	1154704054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA PECK

Provider Business Mailing Address
First Line	:	18621 BLUE ISLAND CT
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-2938
Country	:	US
Telephone Number	:	313-243-6891
Fax Number	:

Provider Business Practice Location Address
First Line	:	18621 BLUE ISLAND CT
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-2938
Country	:	US
Telephone Number	:	313-243-6891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	07/09/2015

Similar Medicare Providers

1982563672 — KAREEN SIMMONS LPN
Practice Location Address:

19110 FRAZHO RD
ROSEVILLE, MI
48066-3500

Practice Phone: 313-367-6163
Practice Fax:

1144032111 — TINA M SMITH MSW
Practice Location Address:

18600 FLORENCE ST STE T6G
ROSEVILLE, MI
48066-6600

Practice Phone: 586-719-4345
Practice Fax:

1063676286 — JIMMY CHARBEL HAOUILOU M.D.
Practice Location Address:

25350 KELLY RD
ROSEVILLE, MI
48066-5824

Practice Phone: 586-270-5100
Practice Fax: 586-270-5111

1023560851 — BLUE WATER COUNSELING AND WELLNESS CENTER, INC.
Practice Location Address:

18600 FLORENCE ST STE T6G
ROSEVILLE, MI
48066-6600

Practice Phone: 586-246-7837
Practice Fax: 586-779-8146

1174184055 — DR. JAMES EMMANUEL TANGALOS DMD
Practice Location Address:

21055 E 12 MILE RD
ROSEVILLE, MI
48066-2205

Practice Phone: 586-789-9528
Practice Fax:

1598783896 — DR. THOMAS A. DRABECKI D.O.
Practice Location Address:

18285 E 10 MILE RD STE 150
ROSEVILLE, MI
48066-5808

Practice Phone: 586-778-1900
Practice Fax:

Directions to “ BRENDA PECK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.