Healthcare Provider Details

I. General information

NPI: 1114287620
Provider Name (Legal Business Name): DARCIE ANNE PETERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W STEWART DR
ORANGE CA
92868-3849
US

IV. Provider business mailing address

400 S. FLOWER ST UNIT #163
ORANGE CA
92868-3402
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-8000
  • Fax: 714-771-8697
Mailing address:
  • Phone: 714-634-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number540692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: