Healthcare Provider Details

I. General information

NPI: 1316167943
Provider Name (Legal Business Name): SHERYL L PETERSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD BLDG 2145 SUITE 258
MESA AZ
85202-4707
US

IV. Provider business mailing address

1400 S DOBSON RD BLDG 2145 SUITE 258
MESA AZ
85202-4707
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-6344
  • Fax: 480-412-6443
Mailing address:
  • Phone: 480-412-6344
  • Fax: 480-412-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN129772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: