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NPI Code Detail

MEDICARE: MS. ANN RENEE PETERSEN L.P.C.C., N.C.C.

MEDICARE: MS. ANN RENEE PETERSEN L.P.C.C., N.C.C.
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
1101YP2500XProfessional Counselor0119911NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2201-047-937OTHERNMPRESBYTERIAN HEALTH PLANS

General Provider Information

NPI Number : 1629170790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN RENEE PETERSEN L.P.C.C., N.C.C.
Provider Business Mailing Address
First Line : PO BOX 3237
Second Line :
City : CORRALES
State : NM
Zip : 87048-3237
Country : US
Telephone Number : 505-400-9913
Fax Number :
Provider Business Practice Location Address
First Line : 4686 CORRALES RD
Second Line :
City : CORRALES
State : NM
Zip : 87048-8610
Country : US
Telephone Number : 505-400-9913
Fax Number : 505-890-1527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 01/21/2025

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Directions to “ MS. ANN RENEE PETERSEN L.P.C.C., N.C.C.” Practice Location

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