Provider Demographics
NPI:1780459669
Name:PETERS, ANETTE A
Entity type:Individual
Prefix:
First Name:ANETTE
Middle Name:A
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 1:9438 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-3600
Mailing Address - Country:US
Mailing Address - Phone:121-653-6730
Mailing Address - Fax:
Practice Address - Street 1:9438 VISTA CT
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-3600
Practice Address - Country:US
Practice Address - Phone:121-653-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide