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General NPI Number Information
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NPI Number | 1114934684
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Entity Type | Individual
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Provider Name | LORI KAY PETERS CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 85 THOMAS JOHNSON CT SUITE D
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City | FREDERICK
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State | MD
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Zip | 21702-4331
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Country | US
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Telephone | 301-797-6389
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Fax | 301-797-4119
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Provider Business Mailing Address
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Address Line | 17 WESTERN MARYLAND PKWY SUITE 100
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5471
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Country | US
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Telephone | 301-797-6389
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Fax | 301-797-4119
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R127498
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN655903
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License Number State | PA
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