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General NPI Number Information
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NPI Number | 1811568918
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Entity Type | Individual
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Provider Name | REBEKAH PETERSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-1545
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Country | US
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Telephone | 608-263-8100
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Fax | 608-262-6247
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Provider Business Mailing Address
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Address Line | 1433 CAMDEN RD
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City | CHARLOTTE
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State | NC
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Zip | 28203-6334
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Country | US
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Telephone | 704-497-5950
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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 | 307601
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 144060
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 007208
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License Number State | NC
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