Healthcare Provider Details

I. General information

NPI: 1831816909
Provider Name (Legal Business Name): ABBY PETERSEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 9TH AVE N
SIBLEY IA
51249-1012
US

IV. Provider business mailing address

36 S 4TH ST
MOVILLE IA
51039-7817
US

V. Phone/Fax

Practice location:
  • Phone: 712-754-2574
  • Fax:
Mailing address:
  • Phone: 712-870-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG191858
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number169768
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: