Provider Demographics
NPI:1215047113
Name:PECK, DEBBE L (NP)
Entity type:Individual
Prefix:MRS
First Name:DEBBE
Middle Name:L
Last Name:PECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:5727 N FRESNO ST
Practice Address - Street 2:# 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6000
Practice Address - Country:US
Practice Address - Phone:559-446-1515
Practice Address - Fax:559-446-1273
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 8144363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ18692ZMedicare ID - Type Unspecified