Basic Information
| Provider Information | |||||||||
| NPI: | 1417367384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REINHARDT | ||||||||
| FirstName: | PEGGIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 354 W MAIN RD | ||||||||
| Address2: | |||||||||
| City: | CONNEAUT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440302043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405992262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2259 LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440043437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409972262 | ||||||||
| FaxNumber: | 4409976507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2014 | ||||||||
| LastUpdateDate: | 10/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.15751-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.