Healthcare Provider Details

I. General information

NPI: 1346473675
Provider Name (Legal Business Name): SARAH PELOVA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8672 KIRKLAND DR
LEWIS CENTER OH
43035-9390
US

IV. Provider business mailing address

8672 KIRKLAND DR
LEWIS CENTER OH
43035-9390
US

V. Phone/Fax

Practice location:
  • Phone: 614-357-5385
  • Fax: 614-754-5019
Mailing address:
  • Phone: 614-357-5385
  • Fax: 614-754-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10929
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: