Healthcare Provider Details

I. General information

NPI: 1538330816
Provider Name (Legal Business Name): CLAUDIA M PETERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 05/25/2023
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17055 RUBEN LN
SANDY OR
97055-9276
US

IV. Provider business mailing address

17055 RUBEN LN
SANDY OR
97055-9276
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-8002
  • Fax: 503-668-5246
Mailing address:
  • Phone: 503-668-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200650138 NP FNP PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: