Healthcare Provider Details

I. General information

NPI: 1336131523
Provider Name (Legal Business Name): CHRISTI L PETERSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GREENLEY RD STE 922
SONORA CA
95370-5287
US

IV. Provider business mailing address

18127 APPLE COLONY RD
TUOLUMNE CA
95379-9626
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-3738
  • Fax: 209-533-9608
Mailing address:
  • Phone: 209-928-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP7349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN265299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: