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General NPI Number Information
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NPI Number | 1053778993
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Entity Type | Individual
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Provider Name | KRISTINE A PETERSON RN, CDE
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Gender | Female
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 1501 TROUSDALE DR FL 4
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City | BURLINGAME
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State | CA
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Zip | 94010-4506
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Country | US
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Telephone | 650-652-8500
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Fax | 650-652-8502
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Provider Business Mailing Address
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Address Line | 577 AIRPORT BLVD STE 300
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City | BURLINGAME
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State | CA
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Zip | 94010-2048
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Country | US
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Telephone | 650-240-8198
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Fax |
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | RN798839
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License Number State | CA
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