MEDICARE: OLUWAYEMISI PECKU MSN, APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	SP023621	PA

General Provider Information

NPI Number	:	1578145611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWAYEMISI PECKU MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	22 HAWK RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19056-1322
Country	:	US
Telephone Number	:	443-854-9388
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 DISSTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1713
Country	:	US
Telephone Number	:	443-854-9388
Fax Number	:

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

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	03/17/2024

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