Provider Demographics
NPI:1700836699
Name:PEAK, TERI S (NP)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:S
Last Name:PEAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:42 N SAINT JOSEPH AVE
Mailing Address - Street 2:101
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2203
Mailing Address - Country:US
Mailing Address - Phone:269-684-6697
Mailing Address - Fax:269-684-5286
Practice Address - Street 1:42 N SAINT JOSEPH AVE
Practice Address - Street 2:101
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-684-6697
Practice Address - Fax:269-684-5286
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71002118A363LA2200X
MI4704246990363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700836699Medicaid
MIMI2051097Medicare PIN