Healthcare Provider Details

I. General information

NPI: 1205580404
Provider Name (Legal Business Name): JENNIFER K PETERSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST
LOVELAND CO
80538-8938
US

IV. Provider business mailing address

3391 ATWOOD DR
LOVELAND CO
80538-4964
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7165
  • Fax: 970-203-7105
Mailing address:
  • Phone: 970-310-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0997322-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: