Provider Demographics
NPI:1336848159
Name:PEYATT, DESIRE
Entity Type:Individual
Prefix:
First Name:DESIRE
Middle Name:
Last Name:PEYATT
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 1:703 QUINBY AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2846
Mailing Address - Country:US
Mailing Address - Phone:330-621-1125
Mailing Address - Fax:
Practice Address - Street 1:703 QUINBY AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2846
Practice Address - Country:US
Practice Address - Phone:330-621-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker