Provider Demographics
NPI:1841896669
Name:PETERS, LISA (CNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9444 EVIEDALE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9285
Mailing Address - Country:US
Mailing Address - Phone:419-704-4004
Mailing Address - Fax:
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 220
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3537
Practice Address - Country:US
Practice Address - Phone:419-517-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily