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NPI Code Detail

MEDICARE: CHRISTINE MARIA PETERSON RD

MEDICARE:   CHRISTINE MARIA PETERSON  RD
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
1133V00000XRegistered Dietitian430NM

General Provider Information

NPI Number : 1598205189
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE MARIA PETERSON RD
Provider Business Mailing Address
First Line : 2450 S TELSHOR BLVD
Second Line : MEMORIAL MEDICAL CENTER
City : LAS CRUCES
State : NM
Zip : 88011-5141
Country : US
Telephone Number : 575-521-5042
Fax Number : 575-521-5045
Provider Business Practice Location Address
First Line : 2100 S TRIVIZ DR
Second Line : SUITE G
City : LAS CRUCES
State : NM
Zip : 88001-0605
Country : US
Telephone Number : 575-556-1849
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2017
Last Update Date : 03/01/2017

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Directions to “ CHRISTINE MARIA PETERSON RD” Practice Location

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