Provider Demographics
NPI:1417558800
Name:PETERS, PEGGY S
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:S
Last Name:PETERS
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 1:190 FOX RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3918
Mailing Address - Country:US
Mailing Address - Phone:234-571-5876
Mailing Address - Fax:
Practice Address - Street 1:323 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-4427
Practice Address - Country:US
Practice Address - Phone:234-571-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7718827373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist