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General NPI Number Information
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NPI Number | 1548396849
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Entity Type | Individual
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Provider Name | SANDRA PETERSEN DNP,APRN, GNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 6800 WEST LOOP S SUITE 180
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City | BELLAIRE
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State | TX
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Zip | 77401-4528
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Country | US
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Telephone | 713-981-6125
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Fax | 713-664-7656
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Provider Business Mailing Address
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Address Line | 6827 DEL NORTE LN SUITE 101
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City | DALLAS
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State | TX
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Zip | 75225-2552
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Country | US
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Telephone | 214-213-4726
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 596367
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License Number State | TX
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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 | 596367
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License Number State | TX
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