Healthcare Provider Details

I. General information

NPI: 1417367384
Provider Name (Legal Business Name): PEGGIE L REINHARDT MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2259 LAKE AVE
ASHTABULA OH
44004-3437
US

IV. Provider business mailing address

354 W MAIN RD
CONNEAUT OH
44030-2043
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-2262
  • Fax: 440-997-6507
Mailing address:
  • Phone: 440-599-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15751-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: