Healthcare Provider Details

I. General information

NPI: 1477369577
Provider Name (Legal Business Name): HANNAH KRISTINA PETERSON BSN, RN, CWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FORT MISSOULA RD STE 101
MISSOULA MT
59804-7424
US

IV. Provider business mailing address

2835 FORT MISSOULA RD STE 101
MISSOULA MT
59804-7424
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-4347
  • Fax:
Mailing address:
  • Phone: 406-327-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberNUR-RN-LIC-198415
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberNUR-RN-LIC-198415
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberNUR-RN-LIC-198415
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberNUR-RN-LIC-198415
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: