Provider Demographics
NPI:1821741042
Name:PEACH, LAURIE LYNNE (RN, MSN, ACNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LYNNE
Last Name:PEACH
Suffix:
Gender:F
Credentials:RN, MSN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:ROBERTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44670-0237
Mailing Address - Country:US
Mailing Address - Phone:330-868-2616
Mailing Address - Fax:
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1111
Practice Address - Fax:330-430-6949
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNS.12354364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health