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General NPI Number Information
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NPI Number | 1073227807
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Entity Type | Individual
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Provider Name | RAMSAY L PETERS
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Gender | Female
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1360 E FAIRWAY DR
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City | EAGLE
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State | ID
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Zip | 83616-5235
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Country | US
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Telephone | 208-805-2097
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 E FAIRWAY DR
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City | EAGLE
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State | ID
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Zip | 83616-5235
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Country | US
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Telephone | 208-805-2097
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-AT-10245307
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License Number State | OR
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