=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356298285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. PATRICIA PETERSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47987 CARMEL ACHOR RD
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44455-9733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-853-1617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47987 CARMEL ACHOR RD
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44455-9733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-853-1617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------