Healthcare Provider Details

I. General information

NPI: 1467744870
Provider Name (Legal Business Name): CAROL JEANNE PETERSON M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RED CREEK DR SUITE 220
ROCHESTER NY
14623-4284
US

IV. Provider business mailing address

UNIVERSITY OF ROCHESTER MEDICAL CTR 601 ELMWOOD AVENUE- BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-487-3480
  • Fax: 585-334-6292
Mailing address:
  • Phone: 585-487-3480
  • Fax: 585-334-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: