Provider Demographics
NPI:1417367384
Name:REINHARDT, PEGGIE L (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:PEGGIE
Middle Name:L
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2043
Mailing Address - Country:US
Mailing Address - Phone:440-599-2262
Mailing Address - Fax:
Practice Address - Street 1:2259 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3437
Practice Address - Country:US
Practice Address - Phone:440-997-2262
Practice Address - Fax:440-997-6507
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15751-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily