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General NPI Number Information
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NPI Number | 1801603774
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Entity Type | Individual
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Provider Name | MRS. AILEEN MARIE PETERSON
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Gender | Female
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 202 JONATHAN DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3153
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Country | US
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Telephone | 910-650-1994
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Fax |
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Provider Business Mailing Address
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Address Line | 202 JONATHAN DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3153
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Country | US
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Telephone | 910-650-1994
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11913
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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