Healthcare Provider Details

I. General information

NPI: 1518886050
Provider Name (Legal Business Name): BRITTNI NICOLE PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N FIFTH ST
DAHLGREN IL
62828-4011
US

IV. Provider business mailing address

505 N FIFTH ST
DAHLGREN IL
62828-4011
US

V. Phone/Fax

Practice location:
  • Phone: 618-383-6870
  • Fax:
Mailing address:
  • Phone: 618-383-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041437200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: