Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 76135 | KS |
N | 363LG0600X | Nurse Practitioner - Gerontology | 76135 | KS |
NPI | 1003223678 |
---|---|
Provider Name | Gina Peek |
First Address | Burlington, KS 66839-9127 |
Second Address | Burlington, KS 66839-9127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 16/07/2014 |