Adina L Peck, DNP, RN, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R 144501-7 Issued in MN

Practice address

3931 Louisiana Ave S
Saint Louis Park, MN 55426-4375

Phone

(952) 993-3248

NPI assigned

Jun 29, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1235493677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 LAMPLIGHTER LN",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223319",
            "telephone_number": "763-544-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3931 LOUISIANA AVE S",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554264375",
            "telephone_number": "952-993-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "ADINA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DNP, RN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R 144501-7",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R 144501-7",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tonya Paulson, PSYD
• Paxxon Healthcare Services LLC
• Matthew M. Paymar, M.A., LPCC
• Gina E Payne
• PDG, P.a.
• Stacie Peckels, MA
• Kerry Pedersen, PA
• David Warren Pederson, DPM
• Ryan A Pederson, PHARMD
• Pediatric Services PA

• Adult Health Nurse Practitioner in Saint Louis Park, MN
• Providers in Saint Louis Park, MN by specialty
• Adult Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.