Healthcare Provider Details

I. General information

NPI: 1568298024
Provider Name (Legal Business Name): JENNIFER MARIE PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 LOCUST ST STE 129
DUBUQUE IA
52001-6700
US

IV. Provider business mailing address

530 CANDLEWICK CT
DUBUQUE IA
52003-8589
US

V. Phone/Fax

Practice location:
  • Phone: 563-590-7009
  • Fax:
Mailing address:
  • Phone: 563-590-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG181274
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: