Provider Demographics
NPI:1497468318
Name:PETERMAN, OLIMPIA
Entity Type:Individual
Prefix:
First Name:OLIMPIA
Middle Name:
Last Name:PETERMAN
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 1:147 N BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44506-1848
Mailing Address - Country:US
Mailing Address - Phone:234-283-2727
Mailing Address - Fax:
Practice Address - Street 1:147 N BLAINE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44506-1848
Practice Address - Country:US
Practice Address - Phone:234-283-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians