Provider Demographics
NPI:1427378728
Name:PETERSON, JANE M (APN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7997 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4226
Mailing Address - Country:US
Mailing Address - Phone:216-851-1880
Mailing Address - Fax:216-707-9370
Practice Address - Street 1:7997 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4226
Practice Address - Country:US
Practice Address - Phone:216-851-1880
Practice Address - Fax:216-707-9370
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN196717163W00000X
OHCOA.02264.NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3069683Medicaid
OHNP41701Medicare PIN