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Individual

MARIANNE PEACOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1115 S UNION ST, TRAVERSE CITY, MI 49684-3258
(231) 935-0550
(231) 935-0551
Mailing address
1115 S UNION ST, TRAVERSE CITY, MI 49684-3258
(231) 935-0550
(231) 935-0551

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704219432
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
08774010
BCBS OF MICHIGAN
MI
01
0B81224
BCBS OF MICHIGAN
MI
01
0P24620
MEDICARE PTAN
MI
01
1245283365
GROUP NPI
MI
01
1386631455
IND NPI
MI
Enumeration date
10/04/2005
Last updated
08/10/2009
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