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General NPI Number Information
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NPI Number | 1588670830
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Entity Type | Individual
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Provider Name | ROBERT CHARLES PETERSON GNP
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 325 E H ST
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-4760
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Country | US
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Telephone | 906-774-3300
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Fax | 906-779-3146
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Provider Business Mailing Address
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Address Line | W5924 SPRINGVIEW DR
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City | NORWAY
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State | MI
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Zip | 49870-2282
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Country | US
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Telephone | 906-563-8231
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Fax | 906-779-3146
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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 | 4704219482
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License Number State | MI
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