Healthcare Provider Details

I. General information

NPI: 1689209843
Provider Name (Legal Business Name): VERONICA PETERS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST STE C
GREENVILLE OH
45331-1396
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1186
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-2319
  • Fax:
Mailing address:
  • Phone: 937-548-3806
  • Fax: 937-548-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.025940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: