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General NPI Number Information
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NPI Number | 1902688526
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Entity Type | Individual
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Provider Name | JENNIFER LYNN PETERSON DNP, FNP, CNL
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Gender | Female
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 1860 OLD STATE RD
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City | VENUS
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State | PA
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Zip | 16364-2316
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Country | US
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Telephone | 412-613-8173
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SHENANGO AVE
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City | SHARON
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State | PA
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Zip | 16146-1503
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Country | US
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Telephone | 814-223-9900
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Fax | 814-223-9910
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP028441
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License Number State | PA
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