Provider Demographics
NPI:1194325878
Name:MCPETERS, TENISHA N
Entity type:Individual
Prefix:
First Name:TENISHA
Middle Name:N
Last Name:MCPETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44506-1108
Mailing Address - Country:US
Mailing Address - Phone:330-998-0510
Mailing Address - Fax:
Practice Address - Street 1:1349 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44506-1108
Practice Address - Country:US
Practice Address - Phone:330-998-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide