Provider Demographics
NPI:1851998132
Name:PETERS, REBECCA ANN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:PETERS
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 1:105 SUPERINTENDENT ROAD
Mailing Address - Street 2:
Mailing Address - City:LORADO
Mailing Address - State:WV
Mailing Address - Zip Code:25630
Mailing Address - Country:US
Mailing Address - Phone:304-583-6115
Mailing Address - Fax:
Practice Address - Street 1:105 SUPERINTENDENT ROAD
Practice Address - Street 2:
Practice Address - City:LORADO
Practice Address - State:WV
Practice Address - Zip Code:25630
Practice Address - Country:US
Practice Address - Phone:304-583-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant