Provider Demographics
NPI:1649953514
Name:PETERS, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
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 1:21 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-8965
Mailing Address - Country:US
Mailing Address - Phone:419-560-5000
Mailing Address - Fax:
Practice Address - Street 1:21 HAZEL ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-8965
Practice Address - Country:US
Practice Address - Phone:419-560-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide