Provider Demographics
NPI:1558307017
Name:PEAK HEALTHCARE, PA
Entity Type:Organization
Organization Name:PEAK HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FNP
Authorized Official - Phone:252-237-5090
Mailing Address - Street 1:2303 WELLINGTON DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8620
Mailing Address - Country:US
Mailing Address - Phone:252-237-5090
Mailing Address - Fax:
Practice Address - Street 1:2303 WELLINGTON DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8620
Practice Address - Country:US
Practice Address - Phone:252-237-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013VTOtherBCBS