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General NPI Number Information
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NPI Number | 1336152586
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Entity Type | Individual
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Provider Name | NANNETTE MARIE PETERSEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 279 N GROVE MEDICAL PARK DR
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City | SPARTANBURG
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State | SC
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Zip | 29303-4222
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Country | US
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Telephone | 864-582-7025
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Fax | 864-583-5715
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Provider Business Mailing Address
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Address Line | 27 RABON VALLEY ACRES RD
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City | FOUNTAIN INN
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State | SC
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Zip | 29644-8605
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Country | US
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Telephone | 864-582-7025
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Fax | 864-583-5715
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS7768
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License Number State | FL
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