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General NPI Number Information
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NPI Number | 1033881669
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Entity Type | Individual
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Provider Name | DANE K PETERSEN NP
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Gender | Male
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 100 N BRENT ST STE 301
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City | VENTURA
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State | CA
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Zip | 93003-2836
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Country | US
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Telephone | 805-653-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N BRENT ST STE 301
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City | VENTURA
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State | CA
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Zip | 93003-2836
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Country | US
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Telephone | 805-653-0101
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Fax | 805-641-0434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95019314
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License Number State | CA
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