Provider Demographics
NPI:1497518666
Name:OTIENO, PETER PATRICK (NURSE)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:PATRICK
Last Name:OTIENO
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 JEFFORDS CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2842
Mailing Address - Country:US
Mailing Address - Phone:484-401-6223
Mailing Address - Fax:
Practice Address - Street 1:131 JEFFORDS CT
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2842
Practice Address - Country:US
Practice Address - Phone:484-401-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN320653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse