Healthcare Provider Details

I. General information

NPI: 1104769793
Provider Name (Legal Business Name): ERICA CHRISTINE PETERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

510 QUINCY RD
QUINCY IN
47456-8604
US

V. Phone/Fax

Practice location:
  • Phone: 812-676-4182
  • Fax:
Mailing address:
  • Phone: 317-447-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28211479C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: