Provider Demographics
NPI:1225673130
Name:PECK, VICKY L (APRN CNP)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:L
Last Name:PECK
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:L
Other - Last Name:SPONSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 W RAHN RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2219
Mailing Address - Country:US
Mailing Address - Phone:937-433-8990
Mailing Address - Fax:937-433-8691
Practice Address - Street 1:33 W RAHN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2219
Practice Address - Country:US
Practice Address - Phone:937-433-8990
Practice Address - Fax:937-433-8691
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner