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General NPI Number Information
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NPI Number | 1356159842
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Entity Type | Individual
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Provider Name | CHET PETERSON RN, CCM, CDCES
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Gender | Male
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 745 RUSSELL ST
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City | CRAIG
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State | CO
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Zip | 81625-2019
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Country | US
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Telephone | 970-824-8233
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Fax | 970-870-1326
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Provider Business Mailing Address
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Address Line | 745 RUSSELL ST
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City | CRAIG
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State | CO
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Zip | 81625-2019
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Country | US
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Telephone | 970-824-8233
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Fax | 970-870-1326
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 4241846
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 32305508
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.1629651
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License Number State | CO
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