Provider Demographics
NPI:1801065842
Name:PEAKE, JEANNIE M (BSN, MSN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:M
Last Name:PEAKE
Suffix:
Gender:F
Credentials:BSN, MSN, CRNP
Other - Prefix:
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Mailing Address - Street 1:215 E BRINGHURST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1719
Mailing Address - Country:US
Mailing Address - Phone:215-844-1020
Mailing Address - Fax:215-844-2702
Practice Address - Street 1:8125 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3530
Practice Address - Country:US
Practice Address - Phone:215-248-7560
Practice Address - Fax:215-248-7564
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP009782363LA2200X
PASP009783363LG0600X
PARN561451163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice