Provider Demographics
NPI:1609619899
Name:PEICKERT, SAMUEL JAMES (RN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAMES
Last Name:PEICKERT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 QUAIL CANYON CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9091
Mailing Address - Country:US
Mailing Address - Phone:336-601-1012
Mailing Address - Fax:
Practice Address - Street 1:1400 SPRING GARDEN ST GREENSBORO NC 27412
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412-0001
Practice Address - Country:US
Practice Address - Phone:336-334-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCROAX34E4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse