Provider Demographics
NPI:1790347219
Name:PEAKE, MIAJENELL JASMINE
Entity Type:Individual
Prefix:MRS
First Name:MIAJENELL
Middle Name:JASMINE
Last Name:PEAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 ODOM WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3644
Mailing Address - Country:US
Mailing Address - Phone:646-832-6511
Mailing Address - Fax:
Practice Address - Street 1:7421 ODOM WAY APT 207
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3644
Practice Address - Country:US
Practice Address - Phone:646-832-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula