Healthcare Provider Details

I. General information

NPI: 1881722866
Provider Name (Legal Business Name): NANCY M PETERSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WENDELL AVE SUITE 1
PITTSFIELD MA
01201-7065
US

IV. Provider business mailing address

280 WEST RD
STEPHENTOWN NY
12168-3613
US

V. Phone/Fax

Practice location:
  • Phone: 413-443-2844
  • Fax:
Mailing address:
  • Phone: 413-499-8568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number195833
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: