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General NPI Number Information
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NPI Number | 1740094598
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Entity Type | Individual
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Provider Name | PETERLAND DHAITI ADETIMIRIN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 333 E BETHANY DR STE J100
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City | ALLEN
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State | TX
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Zip | 75002-3827
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Country | US
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Telephone | 214-777-2085
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Fax |
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Provider Business Mailing Address
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Address Line | 8712 MCCUTCHINS DR
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City | MCKINNEY
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State | TX
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Zip | 75070-3550
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Country | US
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Telephone | 718-813-5109
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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 | 1183816
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License Number State | TX
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