Healthcare Provider Details

I. General information

NPI: 1598681843
Provider Name (Legal Business Name): MCKENNA PETERS RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

5839 CHIPPEWA RD
CHIPPEWA LAKE OH
44215-9613
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8020
  • Fax: 330-543-3808
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.11551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: