MEDICARE: JENNIFER B. PETERS CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	576744	TX

General Provider Information

NPI Number	:	1033109590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER B. PETERS CNM

Provider Business Mailing Address
First Line	:	7733 GRANDWIND DR
Second Line	:
City	:	LORTON
State	:	VA
Zip	:	22079-4738
Country	:	US
Telephone Number	:	703-372-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 FARRELL RD
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5901
Country	:	US
Telephone Number	:	703-805-0599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/08/2007

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