Provider Demographics
NPI:1467635664
Name:PEAKE, CAROL I (CNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:I
Last Name:PEAKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:I
Other - Last Name:PEAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:5830 WOODROW DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1245
Mailing Address - Country:US
Mailing Address - Phone:419-481-3493
Mailing Address - Fax:
Practice Address - Street 1:5830 WOODROW DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1245
Practice Address - Country:US
Practice Address - Phone:419-481-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-177161 NP-09813363LF0000X
MI4704194858 NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1992015135OtherCAROL I PEAKE LLC, NPI 2
OH1467635664OtherNPI 1