Healthcare Provider Details

I. General information

NPI: 1255219879
Provider Name (Legal Business Name): NATHAN PETERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 SPRING VALLEY RD
LONDON OH
43140-9556
US

IV. Provider business mailing address

1847 SPRING VALLEY RD
LONDON OH
43140-9556
US

V. Phone/Fax

Practice location:
  • Phone: 740-837-0230
  • Fax:
Mailing address:
  • Phone: 740-837-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: