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General NPI Number Information
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NPI Number | 1851956072
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Entity Type | Individual
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Provider Name | NICOLE PETERSON LAC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 208 OAK ST STE 106E
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City | ASHLAND
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State | OR
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Zip | 97520-1871
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Country | US
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Telephone | 541-631-9649
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 CLAY CREEK WAY
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City | ASHLAND
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State | OR
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Zip | 97520-8605
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC166652
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License Number State | OR
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