MEDICARE: NIKKI MICHELE PETERSON 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	MW010172	PA
2	367A00000X	Advanced Practice Midwife	F001849	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699906065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI MICHELE PETERSON CNM

Provider Business Mailing Address
First Line	:	17 SHERMAN ST STE 2100
Second Line	:
City	:	JAMESTOWN
State	:	NY
Zip	:	14701-7087
Country	:	US
Telephone Number	:	716-664-8510
Fax Number	:	716-664-8514

Provider Business Practice Location Address
First Line	:	17 SHERMAN ST STE 2100
Second Line	:
City	:	JAMESTOWN
State	:	NY
Zip	:	14701-7087
Country	:	US
Telephone Number	:	716-664-8510
Fax Number	:	716-664-8514

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

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	01/09/2025

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