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General NPI Number Information
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NPI Number | 1568282168
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Entity Type | Individual
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Provider Name | LINDSAY MASHAE PETERSEN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 519 W STATE RD STE 103
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2158
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Country | US
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Telephone | 801-477-4368
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Fax |
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Provider Business Mailing Address
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Address Line | 2096 E EMERALD AVE
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-5368
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Country | US
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Telephone | 435-730-1957
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12087835-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12087835-8900
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License Number State | UT
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