Healthcare Provider Details

I. General information

NPI: 1851317697
Provider Name (Legal Business Name): CARA N. PETERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLARK ST
BUTTE MT
59701-2328
US

IV. Provider business mailing address

PO BOX 84463
SEATTLE WA
98124-5763
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-2500
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN29060
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: