Healthcare Provider Details

I. General information

NPI: 1609159730
Provider Name (Legal Business Name): DEBORAH ANN PETERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 PEBBLE VILLAGE LN STE 200
NOBLESVILLE IN
46062-7411
US

IV. Provider business mailing address

5540 PEBBLE VILLAGE LN STE 200
NOBLESVILLE IN
46062-7411
US

V. Phone/Fax

Practice location:
  • Phone: 317-900-4060
  • Fax: 317-900-4698
Mailing address:
  • Phone: 317-900-4060
  • Fax: 317-900-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001332A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: