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General NPI Number Information
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NPI Number | 1205580404
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Entity Type | Individual
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Provider Name | JENNIFER K PETERSON CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 3520 E 15TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-8938
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Country | US
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Telephone | 970-203-7165
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Fax | 970-203-7105
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Provider Business Mailing Address
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Address Line | 3391 ATWOOD DR
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City | LOVELAND
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State | CO
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Zip | 80538-4964
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Country | US
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Telephone | 970-310-3149
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APN.0997322-NP
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License Number State | CO
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