Provider Demographics
NPI:1851703235
Name:PETERS, CHRISTINA M (RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4009 EDGEFIELD AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1725
Mailing Address - Country:US
Mailing Address - Phone:330-428-3198
Mailing Address - Fax:
Practice Address - Street 1:4009 EDGEFIELD AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1725
Practice Address - Country:US
Practice Address - Phone:330-428-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH479424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106127Medicaid
OH2395975Medicaid