Healthcare Provider Details

I. General information

NPI: 1295844249
Provider Name (Legal Business Name): DELAYNE K PETERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-7741
  • Fax: 402-552-3655
Mailing address:
  • Phone: 402-559-7741
  • Fax: 402-552-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number242
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number242
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: