Provider Demographics
NPI:1649998808
Name:PETERSON, NATATIA MONIQUE (CD, PCD, DEM)
Entity type:Individual
Prefix:MRS
First Name:NATATIA
Middle Name:MONIQUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CD, PCD, DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 301
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBRANCH
Mailing Address - State:OH
Mailing Address - Zip Code:44652
Mailing Address - Country:US
Mailing Address - Phone:330-962-2365
Mailing Address - Fax:
Practice Address - Street 1:3040 WICKER ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721
Practice Address - Country:US
Practice Address - Phone:330-962-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula