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NPI Code Detail

MEDICARE: DEBBIE LYNN PETERSON

MEDICARE:   DEBBIE LYNN PETERSON
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1760064786
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBBIE LYNN PETERSON
Provider Business Mailing Address
First Line : 1752 W GUNSIGHT DR
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-6247
Country : US
Telephone Number : 435-669-1735
Fax Number :
Provider Business Practice Location Address
First Line : 1752 W GUNSIGHT DR
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-6247
Country : US
Telephone Number : 435-669-1735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2021
Last Update Date : 04/28/2021

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Directions to “ DEBBIE LYNN PETERSON ” Practice Location

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