Provider Demographics
NPI:1417223215
Name:PEEK, TARA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:PEEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2223
Mailing Address - Country:US
Mailing Address - Phone:518-605-7210
Mailing Address - Fax:
Practice Address - Street 1:1633 AVENUE A
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2223
Practice Address - Country:US
Practice Address - Phone:518-605-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585452-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse