Provider Demographics
NPI:1336756329
Name:PEASANT, HERBERT ANTHONY
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:ANTHONY
Last Name:PEASANT
Suffix:
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 1:2566 CHESS WOOD PT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9669
Mailing Address - Country:US
Mailing Address - Phone:937-885-3269
Mailing Address - Fax:
Practice Address - Street 1:2566 CHESS WOOD PT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-9669
Practice Address - Country:US
Practice Address - Phone:937-885-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care