MEDICARE: GENNA PEACE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN.473295	OH

General Provider Information

NPI Number	:	1093651135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENNA PEACE NP

Provider Business Mailing Address
First Line	:	914 E SOUTH RANGE RD
Second Line	:
City	:	NORTH LIMA
State	:	OH
Zip	:	44452-9753
Country	:	US
Telephone Number	:	330-921-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2598
Country	:	US
Telephone Number	:	419-383-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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