Individual
AMY SAMANTHA PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3601
Mailing address
4222 NE CLEVELAND AVE, PORTLAND, OR 97211-2704
(503) 866-2746
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
201907329NP-PP
OR
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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