Basic Information
| Provider Information | |||||||||
| NPI: | 1811996176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PECK | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | A.R.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 N 16TH ST | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417446172 | ||||||||
| FaxNumber: | 5417448608 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 N 16TH ST | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417446172 | ||||||||
| FaxNumber: | 5417448608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 200350022NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.