Healthcare Provider Details

I. General information

NPI: 1164604039
Provider Name (Legal Business Name): JANICE R PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HOSPITAL CIRCLE
BROWNING MT
59417-0760
US

IV. Provider business mailing address

PO BOX 1406
BROWNING MT
59417-1406
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6369
  • Fax:
Mailing address:
  • Phone: 406-338-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR020450
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: