Healthcare Provider Details

I. General information

NPI: 1982616827
Provider Name (Legal Business Name): ANNETTE PETERSON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 VETERANS WAY NUTRITION & FOOD SERVICE (120)
FORT HARRISON MT
59636
US

IV. Provider business mailing address

14 REEDERS VILLAGE DR
HELENA MT
59601-9684
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-7334
  • Fax:
Mailing address:
  • Phone: 406-442-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number363
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: