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General NPI Number Information
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NPI Number | 1225013139
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Entity Type | Individual
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Provider Name | BRENDA LYNNE PETERSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 2208 EXECUTIVE DR STE E
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City | HAMPTON
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State | VA
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Zip | 23666-6603
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Country | US
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Telephone | 757-826-7516
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 EXECUTIVE DR STE E
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City | HAMPTON
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State | VA
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Zip | 23666-6603
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Country | US
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Telephone | 757-826-7516
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | UP006027-B
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024167698
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License Number State | VA
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