Provider Demographics
NPI:1073329850
Name:PETERS, BRYAN L (REV)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:L
Last Name:PETERS
Suffix:
Gender:M
Credentials:REV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-9001
Mailing Address - Country:US
Mailing Address - Phone:330-274-7353
Mailing Address - Fax:
Practice Address - Street 1:1672 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-9001
Practice Address - Country:US
Practice Address - Phone:330-274-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner