Provider Demographics
NPI:1811996176
Name:PECK, CRAIG A (ARNP)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:PECK
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 N 16TH ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4175
Mailing Address - Country:US
Mailing Address - Phone:541-744-6172
Mailing Address - Fax:541-744-8608
Practice Address - Street 1:960 N 16TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4175
Practice Address - Country:US
Practice Address - Phone:541-744-6172
Practice Address - Fax:541-744-8608
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350022NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP04658Medicare UPIN