Healthcare Provider Details

I. General information

NPI: 1255265377
Provider Name (Legal Business Name): KAMRIE LYNN PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAMRIE JOHNSON

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N LINCOLN AVE
YORK NE
68467-1030
US

IV. Provider business mailing address

2222 N LINCOLN AVE
YORK NE
68467-1030
US

V. Phone/Fax

Practice location:
  • Phone: 408-362-6671
  • Fax:
Mailing address:
  • Phone: 402-962-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77431
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: