Provider Demographics
NPI:1053378703
Name:KATSARIS PEEPS, SUSAN (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KATSARIS PEEPS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 CHERRY ST
Mailing Address - Street 2:#35
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-0001
Mailing Address - Country:US
Mailing Address - Phone:419-251-3740
Mailing Address - Fax:419-251-3859
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704223394367500000X
OHRN229323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104594620Medicaid
OHP00101745OtherTRAVELER RR
OH2452733Medicaid
MISK223394OtherBLUE CROSS OF MI
MISK223394OtherBLUE CROSS OF MI
MIN24360245Medicare ID - Type Unspecified
OH8232432Medicare PIN
OH2452733Medicaid