MEDICARE: DR. KAREN RENEE PETERSON ND, LAC

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	171100000X	Acupuncturist	AC164788	OR
2	171100000X	Acupuncturist	ACU0002826	CO
3	175F00000X	Naturopath	2017	OR
4	175F00000X	Naturopath	ND2023-0024	NM

General Provider Information

NPI Number	:	1043633217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN RENEE PETERSON ND, LAC

Provider Business Mailing Address
First Line	:	PO BOX 841
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-0841
Country	:	US
Telephone Number	:	503-774-2857
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 W RIM RD
Second Line	:
City	:	CARSON
State	:	NM
Zip	:	87517-8099
Country	:	US
Telephone Number	:	503-774-2857
Fax Number	:

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

Provider Enumeration Date	:	01/24/2014
Last Update Date	:	10/22/2023

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