Healthcare Provider Details

I. General information

NPI: 1316110802
Provider Name (Legal Business Name): PATRICIA A PETERSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N MAIN ST
VALENTINE NE
69201-1527
US

IV. Provider business mailing address

525 N MAIN ST
VALENTINE NE
69201-1527
US

V. Phone/Fax

Practice location:
  • Phone: 402-376-2298
  • Fax:
Mailing address:
  • Phone: 402-376-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number57356
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: