Provider Demographics
NPI:1659658821
Name:PEAVIE-MARTIN, ADA YVONNE (LPN - NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:YVONNE
Last Name:PEAVIE-MARTIN
Suffix:
Gender:F
Credentials:LPN - NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 RANDOMHILL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2432
Mailing Address - Country:US
Mailing Address - Phone:513-258-5933
Mailing Address - Fax:
Practice Address - Street 1:1326 RANDOMHILL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2432
Practice Address - Country:US
Practice Address - Phone:513-258-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN085231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse