Provider Demographics
NPI:1114201522
Name:PECKHAM, SONJA ELAINE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:ELAINE
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 AUBURN RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9615
Mailing Address - Country:US
Mailing Address - Phone:440-354-1802
Mailing Address - Fax:440-953-6138
Practice Address - Street 1:7580 AUBURN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9615
Practice Address - Country:US
Practice Address - Phone:440-354-1802
Practice Address - Fax:440-953-6138
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12655NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health