Healthcare Provider Details

I. General information

NPI: 1598973000
Provider Name (Legal Business Name): COURTENAY BARLOW PETERSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTENAY BROOK BARLOW MD

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 650-690-6385
  • Fax:
Mailing address:
  • Phone: 650-690-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35091292
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA121989
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number16791
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: