Provider Demographics
NPI:1295150506
Name:MUCHENE, PETER SR
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MUCHENE
Suffix:SR
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 1:19157 120TH CT SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-5047
Mailing Address - Country:US
Mailing Address - Phone:614-569-1446
Mailing Address - Fax:
Practice Address - Street 1:4645 TAMARACK BLVD APT 106
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6553
Practice Address - Country:US
Practice Address - Phone:614-569-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN1247817163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health