Healthcare Provider Details

I. General information

NPI: 1790742369
Provider Name (Legal Business Name): LYNN KIRSTIN PETERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 FERGUSON DRIVE
CINCINNATI OH
45245
US

IV. Provider business mailing address

4371 FERGUSON DRIVE
CINCINNATI OH
45245
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-3650
  • Fax: 513-752-3387
Mailing address:
  • Phone: 513-752-3650
  • Fax: 513-752-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34006692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: