Provider Demographics
NPI:1457068454
Name:MUTNANSKY, PETER J
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:MUTNANSKY
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:KIPTON
Mailing Address - State:OH
Mailing Address - Zip Code:44049-0095
Mailing Address - Country:US
Mailing Address - Phone:440-935-3118
Mailing Address - Fax:
Practice Address - Street 1:519 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KIPTON
Practice Address - State:OH
Practice Address - Zip Code:44049-0095
Practice Address - Country:US
Practice Address - Phone:440-935-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care