Provider Demographics
NPI:1659470342
Name:PECK, LIZA KIMBALL (NP)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:KIMBALL
Last Name:PECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ANNE
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:761 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5224
Mailing Address - Country:US
Mailing Address - Phone:508-872-1614
Mailing Address - Fax:508-620-6572
Practice Address - Street 1:761 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5224
Practice Address - Country:US
Practice Address - Phone:508-872-1614
Practice Address - Fax:508-620-6572
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN253707363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110025212AMedicaid
MA1659470342OtherBLUE CROSS BLUE SHIELD OF MA
MA110025212AMedicaid