Robert Wayne Peck, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LP00046874 Issued in WA

Practice address

1315 E Division St
Mount Vernon, WA 98274-4134

Phone

(360) 734-5410

Fax

(360) 816-1652

NPI assigned

Nov 20, 2023

Last updated

Nov 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1740055805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 E DIVISION ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744134",
            "telephone_number": "360-734-5410",
            "fax_number": "360-816-1652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 E DIVISION ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744134",
            "telephone_number": "360-734-5410",
            "fax_number": "360-816-1652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-20",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WA",
            "license": "LP00046874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Pavlich
• Peggy Glass Paxton, MA CCC
• Michael A Payne, ARNP
• Anisa S. Pea, DPM
• Marta Varee Pearson
• Karen Joy Pederson, PT
• Trista Lee Pendergrast, ARNP
• Aparna Pendurthi, M.D.
• Penelope Leggott DDS, Ms
• Amy Pereira, LICSW

• Licensed Practical Nurse in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Licensed Practical Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.