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General NPI Number Information
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NPI Number | 1245900711
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Entity Type | Individual
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Provider Name | REBECCA PETERSON NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 1333 W GRAND RIVER AVE
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City | HOWELL
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State | MI
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Zip | 48843-1980
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Country | US
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Telephone | 517-548-1900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1271
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City | HIGHLAND
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State | MI
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Zip | 48357-1271
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Country | US
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Telephone | 248-521-0365
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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 | 4704243512
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License Number State | MI
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