Provider Demographics
NPI:1902779283
Name:PETERS, JENNY LEA
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LEA
Last Name:PETERS
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 1:5415 LIGHTNER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787-8930
Mailing Address - Country:US
Mailing Address - Phone:740-883-0941
Mailing Address - Fax:
Practice Address - Street 1:5415 LIGHTNER RIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKPORT
Practice Address - State:OH
Practice Address - Zip Code:43787-8930
Practice Address - Country:US
Practice Address - Phone:740-883-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker