Provider Demographics
NPI:1306304167
Name:PEETE, FUNDA RENEE (RN)
Entity type:Individual
Prefix:
First Name:FUNDA
Middle Name:RENEE
Last Name:PEETE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1204
Mailing Address - Country:US
Mailing Address - Phone:337-770-8715
Mailing Address - Fax:
Practice Address - Street 1:4027 HELENA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-1204
Practice Address - Country:US
Practice Address - Phone:330-610-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.169661.MEDS-IV164W00000X
OHRN.518314163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse