Provider Demographics
NPI:1912459827
Name:PECKHAM, ELIZABETH NICOLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SALEM TPKE STE 8
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7403
Mailing Address - Country:US
Mailing Address - Phone:860-886-0023
Mailing Address - Fax:
Practice Address - Street 1:111 SALEM TPKE STE 8
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7403
Practice Address - Country:US
Practice Address - Phone:860-886-0023
Practice Address - Fax:860-886-0024
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9239363LF0000X
MA2279707363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily