Provider Demographics
NPI:1497887426
Name:PEAK, LORETTA R (RNC,WHNP)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:R
Last Name:PEAK
Suffix:
Gender:F
Credentials:RNC,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 E SOUTH FORK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4970
Mailing Address - Country:US
Mailing Address - Phone:602-361-5941
Mailing Address - Fax:
Practice Address - Street 1:4530 E RAY RD
Practice Address - Street 2:172
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6094
Practice Address - Country:US
Practice Address - Phone:480-759-9191
Practice Address - Fax:480-759-9105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN042975363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health