Provider Demographics
NPI:1831106244
Name:PEPONIS, THERESA M
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:PEPONIS
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 1:8599 WHITEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8544
Mailing Address - Country:US
Mailing Address - Phone:513-899-2126
Mailing Address - Fax:
Practice Address - Street 1:8599 WHITEGATE DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-8544
Practice Address - Country:US
Practice Address - Phone:513-899-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH255313163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092677OtherREGISTERED NURSE