Provider Demographics
NPI:1659047728
Name:JETER, DWIGHT
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:JETER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1456
Mailing Address - Country:US
Mailing Address - Phone:740-632-1423
Mailing Address - Fax:
Practice Address - Street 1:824 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1456
Practice Address - Country:US
Practice Address - Phone:740-632-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide