Healthcare Provider Details

I. General information

NPI: 1699952143
Provider Name (Legal Business Name): JULIA PETERSON APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE EMERGENCY MEDICINE RM G909
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON NORTHWESTERN HEALTHCARE
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2114
  • Fax: 847-570-1223
Mailing address:
  • Phone: 847-570-1644
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License Number209006772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: