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General NPI Number Information
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NPI Number | 1093434193
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Entity Type | Organization
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Legal Business Name | WAYSHOWER LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 21449 ROUGHOUT RD
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City | REDDING
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State | CA
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Zip | 96003-8209
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Country | US
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Telephone | 530-262-7025
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Fax | 949-553-3834
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Provider Business Mailing Address
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Address Line | 16590 HEITMAN RD
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City | COTTONWOOD
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State | CA
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Zip | 96022-8004
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Country | US
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Telephone | 530-262-7025
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Fax | 949-553-3834
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Authorized Official
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Title or Position | SOLE MEMBER LLC OWNER
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Name | STEPHANIE ANN PETERSON
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Credential | PMHNP-BC
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Telephone | 530-262-7025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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