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General NPI Number Information
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NPI Number | 1669454062
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Entity Type | Individual
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Provider Name | DAVID PETERSEN R.N.
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Gender | Male
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Dates
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Enumeration Date | 11/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 460 STATE RD #7 STE 300
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411
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Country | US
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Telephone | 561-798-6600
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Fax | 561-204-2042
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Provider Business Mailing Address
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Address Line | 10131 W. FOREST HILL BLVD STE 230
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City | WEST PALM BEACH
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State | FL
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Zip | 33414
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Country | US
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Telephone | 561-798-6600
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Fax | 561-204-2042
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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 | 163WX0800X
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Taxonomy Name | Orthopedic Registered Nurse
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License Number | RN 2555352
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License Number State | FL
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