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General NPI Number Information
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NPI Number | 1740700368
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Entity Type | Individual
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Provider Name | LENA CAROLINE PETERSEN NP
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Gender | Female
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Dates
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Enumeration Date | 06/24/2017
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1225 E CENTERTON BLVD
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City | CENTERTON
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State | AR
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Zip | 72719-1225
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Country | US
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Telephone | 479-795-1301
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Fax | 479-795-1304
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 314-543-6979
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 716670-1
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License Number State | NY
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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 | 342629
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 230416
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License Number State | AR
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