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General NPI Number Information
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NPI Number | 1053827832
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Entity Type | Individual
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Provider Name | CAMERON SCOTT PETERSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 2430 W PIERCE ST
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City | CARLSBAD
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State | NM
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Zip | 88220-3553
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Country | US
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Telephone | 575-887-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 ARCADIA PT
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City | LAS CRUCES
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State | NM
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Zip | 88011-4384
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Country | US
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Telephone | 801-367-5437
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA-01538
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License Number State | NM
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