Provider Demographics
NPI:1336815315
Name:PECK, CHRISTINA DANIELLE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DANIELLE
Last Name:PECK
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 1:268 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:IVYDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25113-8327
Mailing Address - Country:US
Mailing Address - Phone:304-651-6854
Mailing Address - Fax:
Practice Address - Street 1:15 BANK ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043-2504
Practice Address - Country:US
Practice Address - Phone:304-587-9992
Practice Address - Fax:304-587-9993
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant