Provider Demographics
NPI:1083303689
Name:PEETE, MISTY LYNN
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LYNN
Last Name:PEETE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MISTY
Other - Middle Name:LYNN
Other - Last Name:BRISCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26810 COLGATE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3108
Mailing Address - Country:US
Mailing Address - Phone:734-968-0307
Mailing Address - Fax:
Practice Address - Street 1:13111 ALLEN RD BLDG 2
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-968-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program