Provider Demographics
NPI:1356961809
Name:PEEL, CRAIG (FNP-C)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:PEEL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 N 300 E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-6816
Mailing Address - Country:US
Mailing Address - Phone:765-661-3761
Mailing Address - Fax:
Practice Address - Street 1:801 W GARDNER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1819
Practice Address - Country:US
Practice Address - Phone:765-651-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28162730A163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28162730AOtherSTATE OF INDIANA
IN71010084AOtherSTATE BOARD OF NURSING
F05200239OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD