Individual
MARY JANE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PROVIDER
Contact information
Practice address
1126 MARIANNA DR, MANSFIELD, OH 44903-9672
(567) 333-1298
(419) 589-6641
Mailing address
1126 MARIANNA DR, MANSFIELD, OH 44903-9672
(567) 333-1298
(419) 589-6641
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225
—
OH
05
—
2878275
—
OH
Enumeration date
10/21/2020
Last updated
07/30/2024
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