Amy Samantha Peck
Nurse Practitioner, Primary Care in Portland, OR. Individual provider (NPI-1).
NPI number1174170682
StatusActive
Last updated in NPPESAug 20, 2019
Details
- NPI
- 1174170682
- Entity type
- Individual (NPI-1)
- Name
- Amy Samantha Peck
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 20, 2019
- Last updated
- Aug 20, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B No · DME Yes · Home health No · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | 201907329NP-PP | OR | Yes |
Practice location
12710 Se Division StPortland, OR 97236-3134
Phone 503-988-3601
Mailing address
4222 Ne Cleveland AvePortland, OR 97211-2704
Phone 503-866-2746
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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