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General NPI Number Information
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NPI Number | 1316110802
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Entity Type | Individual
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Provider Name | PATRICIA A PETERSEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 525 N MAIN ST
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City | VALENTINE
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State | NE
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Zip | 69201-1527
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Country | US
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Telephone | 402-376-2298
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Fax |
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Provider Business Mailing Address
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Address Line | 525 N MAIN ST
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City | VALENTINE
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State | NE
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Zip | 69201-1527
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Country | US
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Telephone | 402-376-2298
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 57356
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License Number State | NE
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