Provider Demographics
NPI:1346451044
Name:PETERS, PATTI LOUISE (LPN)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:LOUISE
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2769
Mailing Address - Country:US
Mailing Address - Phone:410-222-7003
Mailing Address - Fax:410-222-4150
Practice Address - Street 1:1 HARRY S TRUMAN PKWY
Practice Address - Street 2:SUITE200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7042
Practice Address - Country:US
Practice Address - Phone:410-222-7003
Practice Address - Fax:410-222-4150
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP20368171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator