Healthcare Provider Details

I. General information

NPI: 1811270879
Provider Name (Legal Business Name): EUGENIA ANN PETERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14395 STATE RT 93
JACKSON OH
45640
US

IV. Provider business mailing address

P.O. BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-288-7681
  • Fax: 740-288-7682
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN306869
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18179-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: