Provider Demographics
NPI:1407450620
Name:PEKARI, CARRIE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:PEKARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13335 BOHEMIAN RD
Mailing Address - Street 2:
Mailing Address - City:LORE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43755-9751
Mailing Address - Country:US
Mailing Address - Phone:740-581-1075
Mailing Address - Fax:
Practice Address - Street 1:13335 BOHEMIAN RD
Practice Address - Street 2:
Practice Address - City:LORE CITY
Practice Address - State:OH
Practice Address - Zip Code:43755-9751
Practice Address - Country:US
Practice Address - Phone:740-581-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6100445376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2859778Medicaid