MEDICARE: JANETTE R. PETERSON NP

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	363L00000X	Nurse Practitioner	RN100385 APN7001	TN

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	:	1811983844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETTE R. PETERSON NP

Provider Business Mailing Address
First Line	:	2333 KNOB CREEK RD
Second Line	:	SUITE 16
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2007
Country	:	US
Telephone Number	:	423-975-0764
Fax Number	:	423-975-0141

Provider Business Practice Location Address
First Line	:	2333 KNOB CREEK RD
Second Line	:	SUITE 16
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2007
Country	:	US
Telephone Number	:	423-975-0764
Fax Number	:	423-975-0141

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	02/06/2009

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