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General NPI Number Information
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NPI Number | 1083732093
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Entity Type | Organization
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Legal Business Name | KATHLEEN PETERMAN
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 611 S SEAS
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City | JENSEN BEACH
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State | FL
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Zip | 34957-5341
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Country | US
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Telephone | 772-225-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 611 S SEAS
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City | JENSEN BEACH
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State | FL
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Zip | 34957-5341
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Country | US
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Telephone | 772-225-5777
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. KATHLEEN ELLEN PETERMAN
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Credential | LPN
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Telephone | 772-225-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | PN931913
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License Number State | FL
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