Provider Demographics
NPI:1497532592
Name:PEART, JENNELL LEE
Entity Type:Individual
Prefix:MS
First Name:JENNELL
Middle Name:LEE
Last Name:PEART
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 1:7915 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:CUSTAR
Mailing Address - State:OH
Mailing Address - Zip Code:43511-9704
Mailing Address - Country:US
Mailing Address - Phone:419-429-2569
Mailing Address - Fax:
Practice Address - Street 1:7915 MILTON RD
Practice Address - Street 2:
Practice Address - City:CUSTAR
Practice Address - State:OH
Practice Address - Zip Code:43511-9704
Practice Address - Country:US
Practice Address - Phone:419-429-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker