Healthcare Provider Details

I. General information

NPI: 1235059932
Provider Name (Legal Business Name): KATIE RUTH PETERSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 COUNTY ROAD G
HOOPER NE
68031-1259
US

IV. Provider business mailing address

2163 COUNTY ROAD G
HOOPER NE
68031-1259
US

V. Phone/Fax

Practice location:
  • Phone: 402-654-3317
  • Fax: 402-654-3699
Mailing address:
  • Phone: 402-654-3317
  • Fax: 402-654-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number72433
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: