Healthcare Provider Details

I. General information

NPI: 1396894762
Provider Name (Legal Business Name): JONI PETERSEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8038 LAUREL PARK CIR
RIVERSIDE CA
92509-4096
US

IV. Provider business mailing address

8038 LAUREL PARK CIR
RIVERSIDE CA
92509-4096
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-1816
  • Fax: 951-360-1874
Mailing address:
  • Phone: 951-360-1816
  • Fax: 951-360-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number430092
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number430092
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number430092
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number430092
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number430092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: